VHA SimLEARN
Crash cart educational opportunity offered to Providence inpatient staff
By Spencer Donovan, Pharm.D.
and Alexander Goldman, Pharm.D.
Interprofessional Fellows in Advanced Clinical Simulation
Providence VA Medical Center
PROVIDENCE, R.I. – The Providence VA Medical Center (PVAMC) simulation center is responsible for the training and certification of many clinical staff members in the provision of Advanced Cardiac Life Support (ACLS). In the center’s hands-on ACLS sessions, numerous physicians and nurses expressed unfamiliarity with the crash cart and its contents, especially those clinicians that were relatively new to practice.
Most of the feedback the center received on the crash cart pertained to the medications included in the cart, as the carts in the facility are always sealed shut when they are not in use.
The ability to quickly obtain and use the correct medication or tool in the crash cart is vital to the successful response to emergent situations and patient outcomes in a resuscitation attempt. To address this need, a 10-minute presentation was developed by the simulation fellows and a University of Rhode Island nursing student to educate clinicians about the uses and locations of all items in the crash carts.
This presentation was physically delivered to various inpatient units via a laptop computer on top of a simulated crash cart, which allowed participants to look through a fully-stocked cart at their own pace during the presentation.
To measure the impact of the presentation, 12 scenarios were written in which clinicians would need to rapidly locate items on the crash cart and briefly explain the rationale for their use in each scenario. Six scenarios were used as a pre-presentation assessment, and the remaining six scenarios were given after the presentation, along with a brief survey for each participant.
The presentation was made available to three inpatient units in one day with a total of eleven participants. The fellows observed the nursing student deliver the presentation and recorded how long it took for participants to locate items in the crash cart scenarios, as well as how many attempts they needed to correctly find each item.
Only 35 percent of course participants were able to locate an item on the cart in less than 5 seconds prior to the exercise. This number improved to 79 percent of participants able to correctly locate an item in less than 5 seconds.
Similarly, only 48 percent of course participants were able to locate items on the cart on the first attempt prior to the exercise. This changed to 83 percent after the exercise.
From the information gathered in the surveys several participants indicated that they were “not confident at all” in their knowledge and understanding of the crash cart’s contents prior to the presentation, with all others indicating that they were only “somewhat confident.” Participants’ confidence with the crash cart improved markedly after the presentation with several of the participants indicating that they felt either “confident” or “extremely confident” in their understanding of the cart.
All participants indicated on the survey that they would be able to use the presentation information in their daily practice, and several participants asked that the presentation and cart be made available on a more regular basis going forward for continuing education on the different units.
According to nurse Ashley Anthony, who participated in the training, “The nurses really enjoyed having a quick refresher, especially since we rarely get a chance to see the cart contents outside of a code.”
