A randomized, controlled trial of in situ pediatric advanced life support recertification ("pediatric advanced life support reconstructed") compared with standard pediatric advanced life support recertification for ICU frontline providers*.

OBJECTIVE: Recent evidence shows poor retention of Pediatric Advanced Life Support provider skills. Frequent refresher training and in situ simulation are promising interventions. We developed a "Pediatric Advanced Life Support-reconstructed" recertification course by deconstructing the training into six 30-minute in situ simulation scenario sessions delivered over 6 months. We hypothesized that in situ Pediatric Advanced Life Support-reconstructed implementation is feasible and as effective as standard Pediatric Advanced Life Support recertification. DESIGN: A prospective randomized, single-blinded trial. SETTING: Single-center, large, tertiary PICU in a university-affiliated children's hospital. SUBJECTS: Nurses and respiratory therapists in PICU. INTERVENTIONS: Simulation-based modular Pediatric Advanced Life Support recertification training. MEASUREMENTS AND MAIN RESULTS: Simulation-based pre- and postassessment sessions were conducted to evaluate participants' performance. Video-recorded sessions were rated by trained raters blinded to allocation. The primary outcome was skill performance measured by a validated Clinical Performance Tool, and secondary outcome was behavioral performance measured by a Behavioral Assessment Tool. A mixed-effect model was used to account for baseline differences. Forty participants were prospectively randomized to Pediatric Advanced Life Support reconstructed versus standard Pediatric Advanced Life Support with no significant difference in demographics. Clinical Performance Tool score was similar at baseline in both groups and improved after Pediatric Advanced Life Support reconstructed (pre, 16.3 ± 4.1 vs post, 22.4 ± 3.9; p < 0.001), but not after standard Pediatric Advanced Life Support (pre, 14.3 ± 4.7 vs post, 14.9 ± 4.4; p =0.59). Improvement of Clinical Performance Tool was significantly higher in Pediatric Advanced Life Support reconstructed compared with standard Pediatric Advanced Life Support (p = 0.006). Behavioral Assessment Tool improved in both groups: Pediatric Advanced Life Support reconstructed (pre, 33.3 ± 4.5 vs post, 35.9 ± 5.0; p = 0.008) and standard Pediatric Advanced Life Support (pre, 30.5 ± 4.7 vs post, 33.6 ± 4.9; p = 0.02), with no significant difference of improvement between both groups (p = 0.49). CONCLUSIONS: For PICU-based nurses and respiratory therapists, simulation-based "Pediatric Advanced Life Support-reconstructed" in situ training is feasible and more effective than standard Pediatric Advanced Life Support recertification training for skill performance. Both Pediatric Advanced Life Support recertification training courses improved behavioral performance.

Outcome-Focused Critical Care Orientation Program: From Unit Based to Centralized.

BACKGROUND: An effective orientation ensures that new nurses are prepared to deliver competent care to patients. In organizations with several critical care units, opportunities exist to achieve standardization of core content applicable to all critical care areas. PURPOSE: This quality improvement project, conducted in a large children's hospital with multiple critical care units, was designed to centralize critical care orientation and standardize its content, as well as to measure learning outcomes of the revised program. METHODS: Before initiation of this project, a 2-day critical care orientation class was held regularly for newly hired critical care nurses. Nurses attended this class at different time points in their orientation. Critical care units also held unit-based orientation classes. Nursing professional development specialists and representatives from each critical care unit collaborated to redesign the 2-day critical care orientation class in order to standardize content taught across the organization, increase attendance at the class, and reduce redundancy of topics covered in unit-based classes. INTERVENTIONS: The redesigned program included online modules followed by 4-hour sessions that built on the knowledge gained in the modules. The sessions used multiple learner engagement strategies. Learning outcomes were evaluated using pretests and posttests. RESULTS: Between June 2017 and March 2018, a total of 150 nurses completed the redesigned program. Median posttest scores increased significantly from median pretest scores for each critical care orientation session. CONCLUSION: The program achieved the goal of standardizing education and increasing critical care nurses' knowledge.