Board 192 - Program Innovations Abstract Using Standardized Patients to Teach Central Line Catheter Removal (Submission #700)

Abstract

Introduction/Background In 2011, The Patient Safety/Risk Management Committee at UIC determined there was a need for additional training in performing the removal of central venous catheters to improve technique and reduce the number of associated complications. Our Central Line Removal workshop was developed to provide them with didactic and hands on practice to better equip them for performing this procedure. Methods Checklists were developed for the time out protocol and the removal of central line catheters, then reviewed and validated by the hospital Best Practices Committee. These are specifically meant to guide removal of internal jugular, subclavian, or femoral lines and not for peripherally inserted central catheters (PICC). The checklists are available on our website to allow review at any time, and are referenced during both the didactic and practical training portion of the program. The didactic portion of the workshop includes review of personnel requirements per UIC policy, possible complications and specific indications/contraindications to the timing of catheter removal to reduce the chance of infection. Senior residents in each discipline are trained as trainers for the other residents within their program and function as the clinical experts during didactic review. Practical training consists of the residents utilizing task trainers and skin pads with checklist prompting from qualified instructors. Residents are encouraged to practice both the timevout and removal until they are comfortable with the procedures and are ready to report for assessment. The senior residents are present to give useful feedback on technique and clinical significance throughout the practical training but may not deviate from the checklist steps. For the removal assessment, we replace the skin pads and task trainers with a standardized patient (SP). An instructor from the clinical performance center marks the checklist. Residents are asked to treat the simulation as a real case by communicating with the patient as they would in the medical center. In using SPs for this procedure we can arrange for residents to be better prepared to perform a central line removal, determine whether the patient understands instructions given in preparation of removal and be prepared to handle a complication if one should occur. SPs are trained in the removal procedure and how to respond from a patient’s view as well as what to expect from medical personnel during the removal process. To create a realistic experience for the residents, silicone neck skins are created for each SP with a catheter and sutures already in place. SPs may be instructed to simulate a complication during or immediately after the procedure. In addition, some catheters will have been broken or missing tips to ensure residents are checking for these complications. The SP provides feedback immediately regarding verbal communication with the patient, body language ensuring the patient understands and when necessary, provides suggestions for improvement in the future. Residents are deemed successful once achieving 100% on the checklists. Those who missed few steps may immediately reattempt assessment up to three times until meeting the standard. Those requiring additional practice are referred back to the training stations and may retest once the senior resident determines it appropriate. This remediation process is also followed if any critical actions are missed on the first assessment attempt. Results: Conclusion With conscious patients having an active role during the removal of a central line, the use of SPs appears to be an excellent means for residents to practice. Senior residents have shown to need less practice, however, at a teaching facility the less experienced residents are expected to perform this procedure making the practice time more critical. Residents are receptive to the feedback especially with communication requiring patient participation and instructions for the patient post procedure. Disclosures None.