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(120) A Cognitive Aid for Perioperative Defibrillation: Development and Testing Using a High Fidelity Simulator

Christine R. Valdez, MN/CNS-BC, RN, CNOR; and Laura Devlin, MS, CRNA

Abstract:

In the operating room (OR), the anesthesia provider is often the only Advanced Cardiac Life Support (ACLS)-trained individual. If the patient in the OR requires resuscitation, non-ACLS trained OR personnel are called upon to operate the defibrillator while the anesthesia provider serves as the team leader. Description of the Team: OR staff and Advanced Practice Nurses Preparation and Planning: Cognitive aids have been used effectively to produce performance improvement in procedures which are infrequently done, and in situations where performance pressure is high. To improve resuscitation team function, a cognitive aid for defibrillation was developed and tested. Assessment: In the OR, the anesthesia provider is often the only Advanced Cardiac Life Support (ACLS)-trained individual. Adverse incidents at our facility drew attention to the need for improvement in the performance of defibrillation by OR personnel. Implementation/Objectives: 1. Develop a cognitive aid to improve defibrillation performance by staff; 2. Use the resultant cognitive aid correct steps and safety precautions for effective defibrillation; and 3. Have a permanently-available single-page cognitive aid by the defibrillator. In a simulated patient care environment, we used the Laerdal Sim man to create a scenario for immediate defibrillation. Outcomes: Among individuals able to use the defibrillator and those unable, errors tended to be repeated for the two attempts at defibrillation without the cognitive aid. Scenarios were videotaped for analysis of procedure success/failure and categorization of types of errors made and measurement of time to defibrillation. Implications to Perioperative Nursing: Correct defibrillation procedure and time to defibrillation is related to success of resuscitation efforts.


Primary Author:

Christine Valdez, MN,CNS-BC, CNOR
Perioperative Clinical Nurse Specialist, US Department of Veteran Affairs, Portland VA Medical Center

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