Using Failure-to-Rescue Simulation to Assess the Performance of Advanced Practice Professionals

Abstract

The use of advanced practice professionals (APPs) has been established in oncology care. APPs are frequently the most readily available ordering provider for care guidance when it becomes evident that a patient with cancer is failing. The purpose of the current preliminary descriptive project was to determine the best method for assessing APP performance in oncology-specific circumstances, particularly in the failing patient with cancer. A test group of 14 APPs completed a competency self-assessment, the Basic Knowledge Assessment Tool (BKAT)-8SR, and attended a four-hour simulation and classroom experience. Competency checklists with 30 priority interventions for each scenario had been anticipated by an expert panel. The APP competency self-assessment was measured for knowledge base and critical thinking. All of the APPs scored at or above the level of a critical care nurse with one year of experience on the BKAT-8SR. Twenty-seven of the anticipated interventions were enacted by all APPs. Five additional interventions were ordered that had not been anticipated. The success of this educational strategy has stimulated new learning opportunities, including initiation of a full-team oncology failure-to-rescue simulation, course restructuring, and other innovative simulation experiences.

Failure to Rescue Deteriorating Patients: A Systematic Review of Root Causes and Improvement Strategies

“…Previous case reports of failure to rescue have suggested simulation as a useful tool to educate medical staff in FTR 25 . This has been reflected in advance practice professionals in established oncology care teams after a 4-hour simulation tutorial delivering at or above the level expected of a critical care nurse as assessed by an expert panel 26 …”

“…25 This has been reflected in advance practice professionals in established oncology care teams after a 4-hour simulation tutorial delivering at or above the level expected of a critical care nurse as assessed by an expert panel. 26 Crew resource management is used in the aviation industry was proposed by the Institute of Medicine following their report To Err is Human: Building a Safer Healthcare System 5 as a means of mitigating the problems that arise from poor communication and teamwork. This involves clinical leadership taking active roles in developing team training, integration into standard teaching, use of simulation, and investment at the medical and nursing school level.…”

Simulação clínica e treinamento para as Práticas Avançadas de Enfermagem: revisão integrativa

“…Simulation using complex cases and mannequins permitted improvements in clinical management competencies, use of scientific evidence, patient safety, leadership skills, communication, cooperation and professionalism. 5 Blackburn, Harkless, Garvey, 2014 (30) Descriptive study Advanced practice professionals in oncology (n=14).…”

“…Participants reported being an excellent way to provide real-time scenarios. (30) The Harvey cardiology simulator, a remote-controlled torso with cardiopulmonary sounds, was used to evaluate an educational intervention. Therefore, postgraduate students received a CD-ROM with sounds of cardiologic alterations; before going to the simulated scenario, they took two pretests evaluating cardiovascular cognitive knowledge, physical assessment skills and a self-confidence questionnaire.…”