1. PACU NURSING EDUCATION FOR THE CONGENITAL CARDIAC PATIENT: A QUALITY
IMPROVEMENT INITIATIVE
Michael D. DeBrota, M.S.3., (Clayre E. Tanis-Arens, D.O.), Carly A. Smith, M.D.
Riley Hospital for Children – Indiana University School of Medicine – Indianapolis, IN
Introduction: Patient care in the pediatric post-anesthesia care unit (PACU) requires well-trained medical and
nursing staff (RNs), adequate equipment, and oversight and leadership by anesthesiologists to ensure quality, safety,
and efficacy. A case of sustained oxygen desaturation from baseline in a 3-month-old with hypoplastic left heart
syndrome s/p stage 1 palliative cardiac catheterization prompted our assessment of PACU RNs' knowledge and
implementation of educational intervention to improve communication, quality, and safety for patients with
congenital cardiac defects.
Methods: A five-question survey was distributed to PACU RNs to assess perceived knowledge and comfort with
congenital cardiac patients and when to call for help. Fifteen responses were received. Multimodal interventions
(lecture series, interactive case simulations, job aid reference cards, bedside teaching, and checklists) provided
education in areas of weakness.
A follow-up survey of
knowledge, comfort, and
teaching preference was
conducted, with ten responses
received.
Results and Discussion: Our
educational interventions
resolved participants’ perceived
knowledge gaps of when and
whom to call for help. We also found improvement in the PACU RNs’ self-reported knowledge of congenital
cardiac defects and comfort when caring for these patients. However, as Riley Hospital does not have a dedicated
cardiac PACU, ongoing education and training remain necessary due to high staff turnover. Teaching method
preference survey data indicated beside teaching was most preferred (27% of respondents), followed by job aide
reference cards (24% of respondents), interactive case simulations (22% of respondents), checklists (19% of
respondents), and lectures (8% of respondents). Overall, our interventions increased PACU RNs’ confidence level.
Conclusion: Multimodal education interventions improved PACU RNs' knowledge and comfort in caring for
congenital cardiac patients and clarified understanding of when and whom to call for help in the setting of
undifferentiated patient care and high staff turnover. Ongoing quarterly teaching sessions aim to maintain increased
levels of comfort and understanding for better patient outcomes.
References: Hall SC (1995) J Clin Anesth 7(7):600-5.
Figure 1: (a) Mean self-assigned congenital heart defect knowledge increased
from 2.7 pre-intervention to 4.1 post-intervention. (b) Mean comfort level
caring for cardiac patients increased from 3.4 to 4.0. Scales range from 1 (not at
all knowledgeable/comfortable) to 5 (very knowledgeable/comfortable).