Standardization of health care provider competencies for intrathecal access procedures.

INTRODUCTION: This quality improvement (QI) project addresses a method for experienced health care providers to maintain skill-based competence for intrathecal access procedures. METHODS: A prospective QI design using intrathecal access simulation to assess, educate, and evaluate skill competency. Simulation was used as a strategy to promote patient safety and standardize practice patterns. Pretest and posttest methodology using paired t tests were performed to assess anxiety, confidence, and knowledge. RESULTS: Fourteen pediatric providers participated in this QI project. There was a statistically significant improvement in confidence measuring intracranial pressure (ICP; t = -2.92, P = .013), performance-related overall anxiety (t = -2.132, P = .05) and administering intrathecal chemotherapy (t = -2.144, P = .053). Fifty percent of participants missed a medication error demonstrating confirmation bias. CONCLUSION: This simulation strategy resulted in improved confidence in measuring ICP, performance-related overall anxiety, and confidence in administering chemotherapy. Confirmation bias occurred during simulation testing for a medication error. We propose this method for maintaining clinical competencies in health care providers and introducing new skills to existing practices.

Duke Scholars

Author Colleen A McLaughlin School of Nursing

Author Marilyn J Hockenberry School of Nursing

Author Joanne Kurtzberg Pediatrics, Transplant and Cellular Therapy

Author Remi M Hueckel School of Nursing

Author Paul Langlie Martin Pediatrics, Transplant and Cellular Therapy

Author Sharron Lee Docherty School of Nursing