Simulation-Based Mastery Learning Improves Ultrasound-Guided Peripheral Intravenous Catheter Insertion Skills of Practicing Nurses

Abstract

Introduction: Difficult intravenous (IV) access (DIVA) is frequently encountered in the hospital setting. Ultrasound-guided peripheral IV catheter (USGPIV) insertion has emerged as an effective procedure to establish access in patients with DIVA. Despite the increased use of USGPIV, little is known about the optimal training paradigms for bedside nurses. Therefore, we developed and evaluated a novel, sustainable, USGPIV simulation-based mastery learning (SBML) curriculum for nurses. Methods: This is a prospective cohort study of an USGPIV SBML training program for bedside nurses over a 12-month period. We evaluated skills and self-confidence before and after training and measured the proportion of the nurses achieving independent, proctor, and instructor status. Procedure logs and surveys were used to explore the nurse experience and utilization of USGPIV on real patients with DIVA 3 months after the intervention. Results: Two hundred thirty-eight nurses enrolled in the study. The USGPIV skill checklist scores increased from median of 6.0 [interquartile range = 4.0-9.0 (pretest) to 29.0, interquartile range = 28-30 (posttest), P < 0.001]. The USGPIV confidence improved from before (mean = 2.32, SD = 1.17) to after (mean = 3.85, SD = 0.73, P < 0.001) training (5-point Likert scale). Sixty-two percent of the nurses enrolled achieved independent status, 47.5% became proctors, and 11.3% course trainers. At 3-month posttraining, the nurses had attempted a mean of 35.6 USGPIV insertions with an 89.5% success rate. Conclusions: This novel USGPIV SBML curriculum improves nurses' insertion skills, selfconfidence, and progresses patient care through USGPIV insertions on hospitalized patients with DIVA.

Ultrasound-Guided Peripheral Intravenous Catheter Insertion Training Reduces Use of Midline Catheters in Hospitalized Patients With Difficult Intravenous Access

“…Our study demonstrates that the rate of MC insertions for DIVA significantly decreased across a tertiary care academic institution after training a large number of nurses on USGPIV insertion using an SBML curriculum. This finding is further supported by our previously reported survey data showing that 60% of trained nurses reported personally inserting an USGPIV that directly prevented a PICC or MC 45 . To our knowledge, this is the largest reported educational initiative aimed at reducing PICC and MCs for inpatients with DIVA.…”

“…Over the pilot and intervention periods, 238 nurses enrolled in training, 185 nurses completed the simulation portion of the curriculum and began supervised USGPIV insertions on patients with DIVA, and 148 nurses completed the training to achieve competency for independent insertion 45 . Reasons for course attrition are described elsewhere 45 . Every inpatient hospital unit gained at least 1 nurse independent in USGPIV insertion over the study period.…”

“…45 Reasons for course attrition are described elsewhere. 45 Every inpatient hospital unit gained at least 1 nurse independent in USGPIV insertion over the study period.…”

“…The SBML curricular intervention is described in detail elsewhere 45 . In brief, participants first underwent a skills pretest on simulator using a 30-item checklist.…”

“…Finally, participants underwent a simulated skills posttest where they were required to meet or exceed the MPS. 45 Those who did not meet or exceed the MPS participated in additional deliberate practice until they were able to meet the MPS at retesting. After meeting the MPS, nurses began insertions on real patients who met DIVA criteria while supervised by expert proctors.…”