Use of a High-Fidelity Patient Simulator to Introduce an Evidence-Based Emergency Manual into Certified Registered Nurse Anesthetist Practice

  • James B Hacker U.S. Army Graduate Program in Anesthesia Nursing
  • Paul M Johnson
  • Sandra Bruner
  • Justice Parrott
  • Katherine Alguire
  • Tiffany Uranga
  • Sunny J Yauger
  • Ann Nayback-Beebe

Abstract

Certified Registered Nurse Anesthetists (CRNAs) administer anesthesia care to thousands of patients each year. Despite increased anesthetic safety, low-frequency, high-risk perioperative critical events still occur. Although CRNAs have been expected to rely on memory alone to manage the spectrum of these critical events, the use of an emergency manual (EM) may improve CRNA performance. At one Army community hospital, recent experiences with similar critical events led to the development of the following question: Will the use of high-fidelity simulation training with the staff CRNAs on the use of EMs produce both increased performance in key tasks and positive satisfaction scores related to the use of the emergency manual during critical events now and in the future? Twenty staff CRNAs participated in high-fidelity simulated scenarios involving low-frequency, high-risk critical events before and after training on the use of an EM based on a change strategy developed by Goldhaber-Fiebert and Howard in 2012. Changes in performance after training were evaluated using a tool designed by Arriaga et al. Before EM training, CRNAs completed 46.05% of key tasks in the simulated scenario. After EM training, CRNAs completed up to 94.02% of key tasks in simulated scenarios. The observed increase in the completion of key tasks by CRNAs during simulated critical events after EM training and increase in satisfaction scores demonstrates how a well-constructed training program facilitates the implementation of an evidence-based EM into practice and can improve the quality and consistency of CRNA performance during low-frequency, high-risk perioperative events.

Author Biographies

James B Hacker, U.S. Army Graduate Program in Anesthesia Nursing

Primary Author: LTC James B. Hacker, DNAP, CRNA, AN, USA is a former staff nurse anesthetist at Fort Belvoir Community Hospital and a Doctor of Nurse Anesthesia Practice student at Virginia Commonwealth University.  He now serves as the Program Director, Phase 2 for the U.S. Army Graduate Program in Anesthesia Nursing at Fort Hood, TX. He has no commercial disclosures to make and is the corresponding author for this manuscript with contact information as follows: 

 

James B. Hacker

9992 Brewer Road. Salado, TX 76571

Work email: james.b.hacker.mil@mail.mil

Personal email: james.b.hacker@gmail.com

Home phone: 254-308-0090

Work phone: 254-553-0416

Mobile phone: 210-621-4043

Paul M Johnson

LTC(P) Paul M. Johnson, DNP, CRNA, CHSE, AN, USA was the Director of Clinical Simulation and Clinical Site Director at the Uniformed Services University of the Health Sciences Daniel K. Inouye Graduate School of Nursing Registered Nurse Anesthesia Program, Bethesda, Maryland. He has no commercial disclosures to make.

Sandra Bruner

LTC(ret) Sandra Bruner, DNAP, CRNA is the assistant clinical site director at the Fort Belvoir, Virginia, Nurse Anesthesia Program at the Uniformed Services University of the Health Sciences. She has no financial disclosures to make.

Justice Parrott

CAPT Justice Parrott, DNAP, CRNA, NC, USN is an assistant professor for the Daniel K. Inouye Graduate School of Nursing Registered Nurse Anesthesia Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland. He has no commercial disclosures to make. 

Katherine Alguire

Lt Col Katherine Alguire, DNAP, CRNA, NC, USAF is an assistant professor for the Daniel K. Inouye Graduate School of Nursing Registered Nurse Anesthesia Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland. She has no commercial disclosures to make. 

Tiffany Uranga

CDR Tiffany Ann Uranga, DNP, CRNA, MSN, NC, USN is an assistant professor for the Daniel K. Inouye Graduate School of Nursing Registered Nurse Anesthesia Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland. She has no commercial disclosures to make. 

Sunny J Yauger

Mrs. Sunny Jade Yauger, BS, CHSE, is the Chief of the Department of Simulation 
at Fort Belvoir Community Hospital and Adjunct Instructor for the Uniformed 
Services University of the Health Sciences Daniel K. Inouye Graduate School of 
Nursing Registered Nurse Anesthesia Program, Bethesda, Maryland. She has no 
commercial disclosures to make.

Ann Nayback-Beebe

COL Ann M. Nayback-Beebe, PhD, FNP, AN, USA was the Deputy Director, Department of Research Programs, Walter Reed National Military Medical Center and Adjunct Professor for the Uniformed Services University of the Health Sciences Daniel K. Inouye Graduate School of Nursing Doctoral Studies Program, Bethesda, Maryland. She has no commercial disclosures to make.

Published
2022-05-27
How to Cite
HACKER, James B et al. Use of a High-Fidelity Patient Simulator to Introduce an Evidence-Based Emergency Manual into Certified Registered Nurse Anesthetist Practice. Anesthesia eJournal, [S.l.], v. 10, n. 1, p. 1-7, may 2022. ISSN 2333-2611. Available at: <https://anesthesiaejournal.com/index.php/aej/article/view/88>. Date accessed: 29 nov. 2022.