Validating Chemotherapy Administration Feasible with Simulation-Based Evaluation

Simulation-based evaluation is a feasible, effective method to validate chemotherapy competency.
Simulation-based evaluation is a feasible, effective method to validate chemotherapy competency.

ORLANDO, FL—“Simulation-based evaluation is a feasible, effective method to validate chemotherapy competency and ensure all nurses receive the opportunity to demonstrate competencies in a safe and consistent manner,” a study presented at the ONS 40th Annual Congress has concluded.

The simulation was created to address a specific need: to find an opportunity for the hospital's 93 bedside nurses administering peripheral IV vesicants to meet their annual competency validation, said Lisa Malick, MS, RN, OCN®, University of Maryland Medical Center, Baltimore, Maryland.

Nurses on the cancer center's professional development council, charged with developing an alternative evidence-based validation method to direct observation, “proposed using high-fidelity human simulation for chemotherapy competency validation in our facility's simulation center,” she explained.

“Literature purports that simulation creates a safe haven for learning in a life-like environment without patient risk.”

All oncology nurses were required to attend a 1-hour simulation-based competency to demonstrate vesicant administration, extravasation management, short infusion administration, and emergency response to a hypersensitivity reaction. Nurses had to complete homework prior to participating in the simulation center.

Nurses on the professional development council conducted and evaluated the simulation-based competency assessment, which included a written pre/posttest of six open-ended questions evaluating the effect of simulation on critical thinking skills.

“Pre to post scores improved for 57% of nurses, suggesting that simulation activities had a positive influence on critical thinking,” Malick reported.

The evaluators observed that nurse performance skills varied; approximately 12% did not demonstrate one of the critical actions on a predetermined skills list, prompting additional remedial sessions to assure consistent practice. Subsequently, all nurses who attended the half day remedial session performed the required critical skills.

“Post-simulation satisfaction surveys indicated that 97% of nurses felt simulation was a valuable method for competency evaluation and 97% also felt more confident in chemotherapy administration,” she said.

Practice variations identified included turning off the running IV when there is a suspended reaction and capping off a chemotherapy line when disconnecting the line.

“While not all facilities have high-fidelity simulation centers, we believe that this project can be replicated with similar outcomes using low-cost equipment, a supportive learning environment, and skilled evaluators.”

This year's competency will add administering vincristine via minibag.
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