Nurse-Driven Quality Initiative using High Fidelity Simulation to reduce Failure to Rescue and improve Patient Outcomes

Purpose:
Improve clinical outcomes of post-surgical oncology patients by improving registered nurses' assessment skills, recognition of acutely decompensating patient and initiation of appropriate interventions resulting in decreased Code Blue events and increased Early Response Team events

Significance:
National Quality Forum selected failure to rescue (FTR) as core measure for evaluating nursing care in acute care hospitals. Failure to rescue, according to the 3-year study, accounts for 60,000 deaths each year in Medicare patients under the age of 75.

Strategy and Implementation:
High-fidelity simulation in clinical education helps improve self confidence, clinical judgment, enhances problem solving abilities. Offers opportunities for unlimited practice of rare, critical events in safe, controlled environment without risk to patients. High-fidelity simulation to assess RNs learning needs, develop interventions and evaluate outcomes. Phase I: Assessment of RNs clinical practice by enactment of simulation scenario created from actual patient's chart. Direct observation of RN's responses to changes in patient's status; communicating up the medical chain of command; obtaining/implementing orders; correct use of equipment; requesting resources. Phase II: Education on equipment use, case studies. Phase III: 8 hour didactic on FTR, nursing assessment, respiratory distress and a second simulation exercise. Phase IV consisted of 4 hours of a didactics “Thoracic Surgery and the Oncology Patient”; “Cancer Pain: What you need to know”. Phase V: Evaluation in 12 months

Evaluation:
Pre-defined outcome measures: Increased number of Early Response Team (ERT) events and decreased number of Code Blue events Monthly outcomes data from January 2010 to present indicate Code Blue events were decreased by an average 300% and ERT events were increased by an average 600%.

Implications for Practice:
Simulation can: Identify unit-specific learning needs, targeted interventions Provide realistic practice for high risk/low-volume situations As part of larger educational plan tilization of high-fidelity simulation can result in significant improvements in patient outcomes