(1116) Enhancing the Management of Hypoxia in Ventilated Patients: A Simulation Curriculum for PICU Nurses

Introduction: Ventilated patients with hypoxia have worse outcomes and increased mortality. Clinical reasoning and intervention to reverse hypoxia requires preparedness and skill by bedside nurses. The nursing shortage, rapid staff turnover, and limited clinical experiences contribute to difficulty in obtaining a shared mental model needed to address these events. To improve clinical reasoning and management during hypoxic events for ventilated patients in the pediatric intensive care unit (PICU), we designed a simulation-based curriculum that promotes development of a mental model to address hypoxic events. We hypothesize this training will lead to improvement in clinical reasoning during hypoxic events for ventilated patients in both simulated and real clinical scenarios.

Methods: This study is ongoing, and the curriculum will be provided to all PICU nurses (~80) with two nurses participating together. Five scenarios provide a comprehensive curriculum to cover the most common causes of hypoxia in a Rapid Cycle Deliberate Practice (RCDP) format. The first and final scenarios also serve as pre- and post-assessments using the Rapid Evaluation Assessment of Clinical Reasoning Tool (REACT). To capture baseline clinical reasoning and management during actual hypoxic events, clinical surveys were distributed 3 months prior to curriculum implementation to fill out following desaturation events < 85% and requiring intervention. Pre- and post-simulation REACT data were analyzed using a two tailed paired t-test.

Results: REACT(N=14) showed improvement in mean overall scores from pre- to post-curriculum (9.9/15 vs. 14.2/15, p < 0.05) as well as significant increases in scores for each reasoning category. Preliminary clinical survey results (N=22), identify baseline reasoning skills across the domains of monitor, ventilator, patient assessment and clinical actions: 100% viewed the oxygen saturation, 50% the end-tidal carbon dioxide and 48% the ventilator. For actions: 78% provided ventilator oxygen breaths, 50% suctioned, and 37% bagged.

Conclusions: Preliminary results indicate this RCDP simulation curriculum will improve clinical reasoning and management during hypoxic events in mechanically ventilated patients as measured by REACT, with potential translation to the changes in bedside clinical reasoning and actions.