A Clinical Micro-Systems Approach to Implementing a Respiratory Simulation Education Program (R-SEP)

Purpose:

There are an estimated 44,000-98,000 medical errors annually, and approximately 200,000 cardio-pulmonary arrests of these occur in the hospital setting (IOM, 2008). A review of the literature showed that simulation improved skills and confidence among health care providers, which can lead to improved patient outcomes. The purpose of this quality improvement (QI) project was to implement a respiratory simulation education program (R-SEP) for nurse practitioners (NPs) and evaluate improvements in the respiratory assessment skills of practicing nurse practitioners.

Methods:  The Clinical Microsystems was the framework used to guide this QI project. Evaluation of participants was conducted using a modified respiratory Objective Structured Clinical Examination (OSCE) checklist. The OSCE checklist is a validated and reliable tool that measures performance and skills during simulation. Inter-rater reliability of the OSCE checklist was achieved prior to implementation with greater than 90% consistency among raters.  Practicing nurse practitioners volunteered to participate in this project. The program consisted of two respiratory related clinical scenarios. Participants took part in a simulated experience followed by a debriefing session to review their performance and clinical management. A second scenario was conducted immediately after to incorporate feedback or improvements gathered from first scenario.

Results: Scores of the seven NPs who participated were compared between scenario one (pneumonia) and scenario two (COPD). Six of the seven (71%) improved scores (2.3-25.8%). Results were obtained by comparing mean scores from participants’ first OSCE scores to the second OSCE checklist.

Conclusion: The results of this project add to the body of evidence that simulation programs like the R-SEP can help practicing nurse practitioners maintain skills and necessary competencies.