5 - PACU Preparedness: Using Simulation to Verify Competency

Description: Assessment and Background
This presentation examines how simulation can be used to validate competency and enhance the confidence of nurses working in the Post-Anesthesia Care Unit (PACU). Nurses caring for patients recovering from anesthesia require a high level of skill, clinical reasoning, and nursing judgment to identify early cues that a patient's condition may be deteriorating. In the pre-intervention state, the department manager realized a potential knowledge and skill gap among their staff through observations. The gap was attributed to staff turnover during the COVID-19 pandemic, which led to the hiring of novice nurses.

Description of a Team
This project took place at a community hospital that is part of a larger healthcare network. The department manager, education expert, and simulation expert collaborated to design three simulations using a high-fidelity mannequin to test the knowledge and skills required for basic PACU competencies and understanding of facility policies and procedures.

Planning and Implementation
Three simulations were designed to mimic patient care workflows for a PACU nurse, including receiving handoffs, performing assessments, developing a patient care plan that incorporates management of common post-operative complications with appropriate escalation, conducting discharge assessments, and providing patient education. The patient scenarios assessed management of post-operative nausea and vomiting, electrocardiogram changes, airway management due to inadequate anesthesia reversal, spinal anesthesia complications, and pain management and post-operative hemorrhage protocols. Standardized simulation checklists were developed to assess staff knowledge and skills for each step of the simulation. The simulations were conducted with one to two employees at a time. The debrief consisted of reviewing the simulation, discharge criteria and corelating to facility policies and procedures. A standardized evaluation form was used to measure the effectiveness of the simulation through 13 Likert scale questions and three open-ended questions.

Outcome
Fourteen staff members completed the simulations, and 11 staff members completed the simulation evaluation forms. All staff members rated the simulation Likert scale questions as "agree" or "strongly agree" and provided positive feedback acknowledging personal learning opportunities in the open-ended question section. Knowledge and practice gaps were noted, and additional education is planned to address the gaps. Topics for additional education include reversal agents, massive hemorrhage protocol, team communication, assertive communication, and knowledge of early signs of common complications. This education strategy was effective because it increased staff self-awareness of knowledge and practice gaps, engaging them in their professional development.

Implications for Perioperative Practice
Simulation-based learning is an educational strategy that promotes competence, meets learning goals, and enhances patient safety through an interactive process that simulates learners' real-world responsibilities. Learners can master skills during simulation for high-risk, low-volume events that may occur infrequently and require immediate actions to prevent patient harm. Simulation should be considered as a strategy for assessing competency levels during orientation and periodically, as needed, for specific competencies.