Background: The occurrence of a fire when implementing anesthesia is a high-risk, low-frequency event. The operating room is a high-stakes environment that has no room for error. Mixed reality simulation may be a solution to better prepare healthcare professionals. The purpose of this quantitative, descriptive study was to evaluate the technical and non-technical skills of student registered nurse anesthetists (SRNAs) who participated in a mixed reality simulation of an operating room fire. Methods: Magic Leap OneTM augmented reality headsets were used by 32 student registered nurse anesthetists to simulate an emergent fire during a simulated tracheostomy procedure. Both technical and non-technical skills were evaluated by faculty members utilizing a checklist. Results: The SRNAs’ overall mean technical skill performance was 18.16 ± 1.44 out of a maximum score of 20, and the mean non-technical skill performance was 91.25% out of 100%. Conclusions: This study demonstrated the utility and limitations in applying novel technology in simulation. Participants demonstrated a strong performance of technical and non-technical skills in the management of a simulated operating room fire. Recommendations for future applications include the use of multiple sensory inputs into the scenario design and including all core team members in the immersive mixed reality environment.
Approximately one in three women in the United States deliver via Cesarean section (CS), making it one of the most common surgical procedures in the country. Neuraxial (spinal or epidural) anesthesia is the most effective and common anesthetic approach for pain relief during a CS in the United States and often associated with adverse effects such as nausea, vomiting, and pruritus. While recommended dose ranges exist to protect patient safety, there are a lack of guidelines for opioid doses that both optimize postoperative pain management and minimize side effects. This integrative review synthesizes the evidence regarding best practice of opioid dosing in neuraxial anesthesia for planned CS. Evidence supports the use of lower doses of intrathecal (IT) opioids, specifically 0.1 morphine, to achieve optimal pain management with minimal nausea, vomiting, and pruritus. Lower IT doses have potential to achieve pain management and to alleviate preventable side effects in women delivering via CS.
Background: Poorly executed handoffs, particularly those omitting important clinical information or conveying ambiguous instructions, increase the risk of adverse events among anesthetized patients. Currently, there are no specific standards for the training and assessment of anesthesia care handoff among student registered nurse anesthetists. The Anesthesia SBAR (AneSBAR) Handoff Rubric was developed to assess nurse anesthesia students on their SBAR (Situation, Background, Assessment, Recommendation) reporting skills. Method: Nine anesthesia professionals participated in instrument validation. Thirty-four nurse anesthesia students participated in simulations involving patient handoff. Anesthesia professionals were surveyed on validity of the rubric. Nurse anesthesia students practiced simulated performances of surgical patient handoff and were rated using the rubric. Results: The rubric was determined reliable and valid. Conclusion: The AneSBAR Rubric may be useful to teach, assess, and implement in simulation as a cognitive aid to assure complete and accurate transfer of patient information.
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