1. INDIANA UNIVERSITY SCHOOL OF MEDICINE DEPARTMENT OF ANESTHESIA – MARC 2023
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 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 cardiac catheterization
prompted assessment of PACU RNs' knowledge and
implementation of educational intervention to improve
communication, quality, and safety for patients with congenital
heart disease (CHD).
METHODS
A survey was distributed to PACU RNs collecting self-ratings
assessing the following areas:
• Perceived knowledge of congenital cardiac defects
• Comfort level caring for CHD patients
• Knowing when to call for help
• Knowing who to call for help
Responses were on a scale ranging from 1 (no
knowledge/comfort) to 5 (very knowledgeable/comfortable).
Education methods used included lecture series, interactive
case simulations, and bedside teaching. Subsequently, a
follow-up survey was distributed to participants, reassessing
their rating in the above categories.
DISCUSSION
In total, 15 responses were received to the initial pre-
education survey and 10 responses were received on the
post-survey.
Prior to education, the mean self-assigned perceived CHD
knowledge level was 2.7, and cardiac patient care comfort
was 3.4. Both measures showed improvement with teaching
to 4.1 and 4.0, respectively.
Our educational interventions resolved participants’ perceived
knowledge gaps of when and whom to call for help.
Preferred teaching methods were reported as follows:
• Bedside teaching (27%)
• Job aids (24%)
• Simulation (22%)
• Checklists (19%)
• Lectures (8%)
REFERENCE
Hall SC (1995) J Clin Anesth 7(7):600-5.
Figures: (top) pre and post results of knowing who and when to call for help. (bottom) Mean self-assigned congenital heart defect
knowledge increased from 2.7 pre-intervention to 4.1 post-intervention. 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).
67
%
0%
33
%
PRE-Education:
Do you know WHO to
call for help?
Yes No Unsure
100
%
0%
0%
POST-Education:
Do you know WHO to
call for help?
Yes No Unsure
62
%
0%
38
%
PRE-Education:
Do you know WHEN to
call for help?
Yes No Unsure
100
%
0%
0%
POST-Education:
Do you know WHEN to
call for help?
Yes No Unsure
CONCLUSIONS
Because Riley Hospital does not have a dedicated cardiac
PACU, ongoing education and training remain necessary due
to high staff turnover rate and knowledge attrition over time.
Development of job aids and checklists is ongoing. Overall,
our interventions increased PACU RNs’ confidence and will
thereby potentially improve patient outcomes.