Standardization of Health Care Provider Competencies for Intrathecal Access Procedures

Abstract

Introduction: This quality improvement (QI) project addresses a method for experienced health care providers to maintain skill-based competence for intrathecal access procedures. Methods: A prospective QI design using intrathecal access simulation to assess, educate, and evaluate skill competency. Simulation was used as a strategy to promote patient safety and standardize practice patterns. Pretest and posttest methodology using paired t tests were performed to assess anxiety, confidence, and knowledge. Results: Fourteen pediatric providers participated in this QI project. There was a statistically significant improvement in confidence measuring intracranial pressure (ICP; t = −2.92, P = .013), performance-related overall anxiety (t = −2.132, P = .05) and administering intrathecal chemotherapy (t = −2.144, P = .053). Fifty percent of participants missed a medication error demonstrating confirmation bias. Conclusion: This simulation strategy resulted in improved confidence in measuring ICP, performance-related overall anxiety, and confidence in administering chemotherapy. Confirmation bias occurred during simulation testing for a medication error. We propose this method for maintaining clinical competencies in health care providers and introducing new skills to existing practices.