Assessment of a simulation-based implementation method to support the introduction of a new invasive device: a prospective cross-over study.

Abstract

Study objective: The introduction of new medical devices into care units, or their replacement by new devices, is not always accompanied by implementation strategies that enable healthcare professionals to use them safely. Simulation is a relevant tool for reproducing critical care clinical situations without danger for the patients and providing training support. The aim of the study was to assess a simulation-based implementation method to accompany and reduce the risks associated with the deployment of a new invasive medical device in critical care units.

Design: Prospective mono-centric cross-over study.

Setting: In our hospital, the type of Invasive Arterial Blood Pressure Sensors (IABPS) for blood pressure (BP) monitoring and arterial sampling has been completely replaced by a new one with numerous differences. No specific training had been planned.

Participants: 66 intensive care unit (ICU) nurses from three ICUs with a total number of 39 beds were involved.

Interventions: The scenario and evaluation grid were designed by multi-disciplinary teams who received in-depth training on the new IABPS from the laboratory and the institution's equipment specialists. Nurses in group A (GA) (n=33) started by using the IABPS on a simulation scenario and then received explanations on differences. Nurses in group B (GB) (n=33) received explanations and then used the IABPS on the simulation scenario. Nurses in GA and GB all had individual feedback on their errors at the end. Next, they listed the most important information they would give to a colleague if they had a few minutes to train him or her. They also completed an anonymous self-questionnaire to assess their satisfaction with the training and with the new IABPS.

Main results: The mean number of errors in the act of measuring BP and taking biological samples was statistically higher for GA, demonstrating the relevance of offering a training programme to support the deployment of a new device. The mean times to BP measurement and to collection were similar. Recommendations for asepsis of the sampling site were not followed. Recurrent errors were related to the ergonomics of the IABPS. Caregivers (n=55 questionnaires) appreciated the training and the new IABPS.

Conclusions: Simulation can be useful for both providing a training model and identifying the situations that would require dedicated training support. The simulation tool provided training and context to nurses before they use the new IAPBS in clinical practice. Simulation training has also led to a better understanding of the most common errors. Because of new IABPS widespread use, it was all the more important to prevent usage errors.