Rolling Refresher Emergency Department Pediatric Code Cart Training Program

Abstract

Session C presented Thursday, September 27, 1:00-2:00 pm Purpose: Emergency department RN’s and paramedics manage the code cart during the infrequent pediatric emergencies which occur in our rural tertiary medical center. In an attempt to educate on this low frequency, high risk skill, a rolling refresher training program was developed. Design: An uncontrolled intervention study was completed with 6- month follow-up. This project was approved by the local Institution Review Board. A collaboration of MD and RN experts developed a training program consisting of four scenarios, including twenty one code cart skills based on Pediatric Advanced Life Support (PALS) algorithms. The scenarios included shock, ventricular fibrillation, asystole, and supraventricular tachycardia. Setting: Training sessions were held in an empty emergency department room. The room would be set up with a hospital wide standardized pediatric code cart, defibrillator, a syringe pump and infusion pump and both an infant and child manikin. Participants/Subjects: A total of forty-one participants were included in the initial training which was open to all emergency department nurses and paramedics. Of the initial cohort, twenty-one were able to complete a second training 6 months later. Of those who participated in this rolling refresher program, 34% had never participated in a pediatric code and additional 32% having greater than 12 months since their last pediatric code. Methods: Each participant underwent an initial, monitored competency assessment. If a skill was not performed competently within the established time, the participant received immediate feedback and instruction and repeated the task to mastery in training 1. The competencies were repeated 6 months later, designated training 2. Results/Outcomes: A total of twenty one participants completed two trainings and were included in the statistical analysis. Results are encouraging with statistically significant data in the percentage of first attempt successes in three different skills including obtaining supplies to place an IV and send labs (p 0.002), drawing up epinephrine in a cardiac arrest (p 0.01), and drawing up and administering adenosine (p 0.01). Although not significant, the data also shows an increase in the percentage of first attempt successes in all but one skill. Implications: Our training program demonstrated improvement on a majority of these low frequency, high risk skill after an initial and repeat training after 6 months. We believe our training program can serve as a model for educating emergency providers on low-frequency, high risk skills with ongoing competency with repeated training.