Millikin DNP student creates check sheet for safe anesthesia delivery
Decatur Memorial Hospital and Millikin University having been teaming up since 2010 to offer a Nurse Anesthesia Program. The program is the first track within the Millikin School of Nursing Doctor of Nursing Practice (DNP) degree program.
Students seeking a Millikin DNP degree are required to complete a project that focuses on patient safety, cost reduction and improved patient outcomes, and Dana Flatley, CRNA and DNP assistant program director for the Millikin/DMH Nurse Anesthesia Program, had a good project idea in mind for one of her students.
For any particular surgery, patients will receive some type of anesthesia to keep them comfortable. But before that process takes place, it's vital to prepare for anesthesia to help ensure a successful procedure, including having the necessary items for a safe anesthetic delivery.
To help new DNP students ensure that all anesthetic delivery items are in order prior to surgery, Flatley asked Millikin student Nick Halford, a second-year DNP Nurse Anesthesia intern, to develop a check sheet for an anesthesia workstation. The purpose of the check sheet is to help avoid any oversights of critical elements for the anesthesia workstation.
"I wanted Nick (Halford) to develop a check sheet that had to do with the setup of the anesthesia equipment," said Flatley. "At the time, Nick had no experience with anesthesia because he was spending 18 months taking classes at Millikin before he started his 18-month clinical work at DMH."
To do this, Halford worked with DNP senior interns to develop a worksheet called the Anesthesia Specific Patient Safety Tool (ASSIST). The tool was first introduced to students who were beginning their first clinical rotation in summer 2018.
"My job was to create a list that was going to help my class, and future classes, be able to have a reference tool to help them set up in the mornings," said Halford. "For the students, we're transitioning from a different area of nursing practice and nobody had given anesthetic before. We don't know what to look for, what we need and what equipment we need to have, and this check list would help people, who are giving anesthesia for the first time, know what to gather and be prepared whenever it comes time to put the patient in the room."
To determine if the tool was effective, Halford reviewed student evaluations from 2017, prior to the ASSIST tool, and saw that eight omissions of the anesthesia setup were found. Fast forward to 2018, after the ASSIST tool was implemented, and only two omissions were found after reviewing student evaluations.
"It was challenging to put the list together since I never did it before, but I compiled a list of different equipment, including subcategories, and took the list to other people to ask for their opinion on what they thought was necessary," the Decatur (Ill.) native said. "Once we implemented the tool, we evaluated to see if it helped by looking at the class ahead of ours. We saw that there was a reduction in incidents on the clinical evaluation forms."
Halford also surveyed the students to collect satisfaction data including asking the students if they utilized the check list.
"When students use the check list, their setup is complete and they have everything that they need," said Halford. "It took me about a four-month time period to compile the list."
In 2015, the Anesthesia Patient Safety Foundation (APSF) began an awards program called the Resident Quality Improvement Recognition Program as a way to allow physician anesthesia students to showcase their patient safety projects. Recently in 2018, the APSF opened the awards program to all students of anesthesia: physicians, nurses and assistants. The program was also renamed as the Trainee Quality Improvement Program (TQI).
This past summer, Halford submitted his project for an APSF Award by creating a four-minute video showcasing the ASSIST tool and how it was implemented. Halford's video received the 2nd Place Award in the Anesthesia Patient Safety TQI Program category. Halford accepted the award at the 2018 American Association of Nurse Anesthetists Annual Congress meeting in Boston on Sept. 23.
"I didn't think the video would get recognized on such a large scale," said Halford. "In a lot of areas it comes down to patient safety, and these types of check lists have been implemented throughout all kinds of areas in the hospital to help make sure you hit every point, every time."
Halford earned a Bachelor of Science in Nursing from Millikin in 2014, but he wanted to have more responsibility and decided to pursue the DNP.
"I really enjoyed the procedural things I did, even at bedside, and I wanted to expand that into a broader scope," said Halford. "I've always had a passion for nursing and sciences, and feeling like I'm making a difference."