Higher Risk for Adverse Outcomes
Froedtert Hospital has a well-established Mechanical Circulatory Support (MCS) and Extracorporeal Membrane Oxygenation (ECMO) program. However, situations can be encountered within this patient population that can put them at a higher risk for adverse outcomes. These situations include air entrainment, accidental decannulation, malposition cannula, motor failure and emergent need for the addition or change of an oxygenator, emergent bedside cannulation and clot formation within the cannula or circuit leading to pump stoppage.
Interdisciplinary Team Manages ECMO Simulations
The interdisciplinary team caring for this unique patient population includes cardiothoracic surgeons, critical care anesthetists, perfusionists, ECMO coordinators, respiratory therapists, Cardiovascular Intensive Care Unit (CVICU) charge nurses and bedside nurses. Even though CVICU nursing staff are highly trained in critical care, an opportunity was identified to increase the interdisciplinary team’s knowledge of how to manage adverse outcomes for these patients through the use of high-fidelity ECMO simulations.
Advanced Simulation Technology Aids in Clinical Scenarios
The ECMO nurse coordinators worked closely with the Simulation team, CVICU educators and providers to develop clinically-based scenarios using the advanced technology in the Froedtert Hospital Simulation Center. The high-fidelity ECMO simulations create an environment where the multidisciplinary team works together in the practice environment to provide appropriate interventions. Following each clinical scenario, the team engages in a debrief to discuss the actions taken in the simulated scenario and the clinical applications.
Hands-On ECMO Simulation Training
The need for additional education was identified when reviewing the post-simulation evaluation surveys. The surveys indicated the need for more hands-on practice to improve confidence in caring for the ECMO patient population. The ECMO coordinators developed a weekly “Sunday Pump Day” to provide hands-on practice for staff caring for ECMO patients. Staff are able to practice clamping cannulas, switching to back-up devices in the event of failure and other emergency interventions.
Increased Confidence and Proficiency for ECMO Teams
The high-fidelity ECMO simulations have made the interdisciplinary ECMO management team more proficient and able to provide collaborative care for this unique patient population. Bedside disciplines are now able to more confidently intervene while waiting on the more specialized disciplines to provide further care during emergent situations. More hands-on practice on the devices used by all staff has increased the confidence and proficiency of the disciplines that make up this team, thereby reducing adverse patient outcomes.
