Learning Objective #1: Identify methodologies for incorporating evidence-based practices into clinical practice

Learning Objective #2: Discuss the use of human simulation technology for evaluation of competence

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Background: A Level I trauma center, a teaching hospital with multiple critical and progressive care units, and the expectation of being 95% telemetried by 2007 is the setting for high patient acuity. The level of expertise needed to provide optimal patient care and concomitantly anticipate/prevent complications demands creative educational processes to transition clinicians from novice to expert. Problem: Based upon issues identified during peer and code reviews, it was determined that recognition of respiratory distress and timely intervention were problematic in both critical care and progressive/medical-surgical care areas. A two-tiered program was developed to meet both the educational challenges and also develop expertise related to airway management. Description: The Respiratory Advanced Life Support (RALeS) Provider level targets airway emergencies associated with non-mechanically ventilated patients. A variety of modules, videos and CD-roms are used for foundation. The modules incorporate the most current evidence based practices, and focus on common respiratory pathophysiologies, arterial blood gas interpretation, and fundamental management of airway emergencies inclusive of oxygen delivery devices, airway adjuncts, suctioning, tracheostomy care, and chest tube management (all of which were identified through peer review). The RALeS-Experienced Provider (EP) level is directed at development of comprehensive ventilator assessment and management. Advanced pulmonary physiology concepts, intubation procedures, and ventilator graphics assessment are part of the EP level. To evaluate competency, both levels require skills validation and application of the nursing process utilizing high fidelity simulation. The clinician responds to the scenario in “real time”, and is subsequently debriefed. Outcomes: Since its inception, our critical care and respiratory therapy departments are including RALeS as part of career advancement. Lower rates of ventilator acquired pneumonia and prevention of complications have been identified through chart reviews. Acceptance of the provider level has been slower as it is associated with a paradigm shift within the hospital.