The effects of using a flipped classroom pedagogy in nursing anesthesia education: a program evaluation.

BACKGROUND: The flipped classroom (FC) pedagogy improves undergraduate student proficiency and satisfaction. However, its effectiveness has not been demonstrated in nursing anesthesia education. OBJECTIVES: Pre- and post-FC tests and course evaluations were retrospectively compared to determine if FC was an effective pedagogy for a nursing anesthesia program (NAP). METHODS: The design of the study was a retrospective program evaluation. Two groups were compared with 59 students in the pre-FC group taught via traditional lecture and 61 students in the post-FC group taught with FC. Answers to the same 167 test questions were compared using an independent t-test and five course evaluation questions were statistically compared using NPAR1WAY procedure with the Wilcoxon option to determine if significant differences existed between the two nursing anesthesia student cohorts. RESULTS: The post-FC students exhibited a significant 4 % increase in test scores and expressed increased satisfaction compared to their pre-FC counterparts. CONCLUSIONS: This retrospective program evaluation showed that student proficiency and satisfaction improved between the groups after changing to the FC pedagogy. However, research is needed to determine the true value of using FC in nursing anesthesia education. IMPLICATIONS FOR AN INTERNATIONAL AUDIENCE: The flipped classroom model can be beneficial in graduate nursing education with our ever-changing student population.

Implementation of a Massive Transfusion Protocol: Evaluation of Its Use and Efficacy.

Massive transfusion protocols (MTPs) allow practitioners to follow a prescribed algorithm for the rapid replacement of blood products during a massive hemorrhage. They function as an established protocol to provide consistent treatment. Once implemented, the MTP must be evaluated to ensure best practice. The purpose of this clinical improvement project was to formally evaluate the use and efficacy of an MTP during its first year of implementation. The specific aims were to (1) determine whether MTP activations were missed; (2) compare outcomes between those patients managed by the MTP and those who were not; and (3) provide recommendations to the institution's stakeholders. A retrospective medical record review was conducted with 101 electronic medical records of adult trauma patients treated over 1 year. Patients were identified to have experienced massive bleeding if their medical record contained 1 of 4 indicators: (1) transfusion of uncrossmatched blood; (2) tranexamic acid administration; (3) transfusion of 4 or more units of packed red blood cells (PRBCs) in 1 hr; and/or (4) transfusion of 10 or more units of PRBCs in 24 hr. While 58 patients experienced massive bleeding, only 16 (28%) were managed using the MTP. Although the non-MTP group received fewer transfused blood products due to higher initial and 24-hr hemoglobin levels, more deaths occurred in this group than in the MTP group. The recommendations were to (1) establish well-defined criteria for MTP activation based on the 4 indicators of massive bleeding and (2) regularly evaluate the use and efficacy of the MTP to ensure positive patient outcomes.

Evaluation Tool for Assessing a Newly Implemented Massive Transfusion Protocol.

Exsanguination requires massive blood product replacement and termination of the bleeding source to prevent hemorrhagic shock and death. Massive transfusion protocols (MTPs) are algorithms that allow the health care team to quickly stabilize the bleeding patient and guide blood product administration. However, no national MTP guidelines or a standardized evaluation tool exist for collecting and reporting MTP-related data. The purpose of this article is to describe an original MTP evaluation tool, how it was used, barriers encountered, and a framework for reporting the MTP evaluation data. The evidence-based Broxton MTP Evaluation Tool was developed to evaluate the use of a newly implemented MTP via a retrospective review of electronic medical records (EMRs). Although the instrument itself worked well, barriers were encountered while reviewing the EMRs for the MTP evaluation. These barriers included no institutional entity was charged with tracking MTP activations, no searchable database was established to collect data concerning the MTP-activated patients, and no standard location in the EMR was designated for documenting the MTP activation. When devising protocols such as an MTP, a priori strategies should be developed for its implementation, documentation, and evaluation. Research is needed to determine best practices for evaluating an MTP to ensure positive patient outcomes with this protocol.