Impact of an Interdisciplinary Simulation Training on Provider Confidence and Competence in the Management ff a Local Anesthetic System Toxicity Critical Incident

Abstract

The purpose of this Doctor of Nursing Practice (DNP) Project was to examine the impact of a critical incident (CI) team training event on clinician confidence and competence in managing a local anesthetic systemic toxicity (LAST) CI at an ambulatory surgery center located in Western New York (WNY). The National League for Nursing (NLN) Student Satisfaction and Self-Confidence in Learning questionnaire and a CI questionnaire developed by the DNP project student were utilized to collect data. Following approval by the University at Buffalo (UB) Institutional Review Board (IRB), 16 clinicians were voluntarily recruited from the study site. Results from pre and post intervention survey instruments were statistically significant. Mean confidence and perceived competence scores improved from 3.32/5 to 4.26/5 (p = 0.001). Similarly, competence scores improved by 30.5% (p = 0.000) following the CI training. Key findings emerged from the training and qualitative analysis, most notably a lack of institutional and individual preparedness to effectively manage a CI, including LAST. This study shows promise with regards to the efficacy of staff training to improve the individual clinicians’ confidence and competence in the management of a CI, while identifying site specific deficiencies to be addressed that may avert untoward patient outcomes in the event a CI were to occur. To more broadly apply findings, additional research is needed at multiple centers with a larger sample size and a longitudinal component to evaluate participants’ retention of CI content.