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Ultrasound Use and Training Available to CRNAs Ultrasound Use and Training Available to CRNAs

Ultrasound Use and Training Available to CRNAs - PowerPoint Presentation

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Ultrasound Use and Training Available to CRNAs - PPT Presentation

Dustin Hunter RNAI Josh Leppert RNAI Gonzaga University Sacred Heart Medical Center Master of Anesthesiology Education Background The use of ultrasound technology when performing invasive procedures is becoming progressively more ID: 624495

training ultrasound safety anesthesia ultrasound training anesthesia safety patient regional medical technology 2012 amp practice participants crnas anesthetic procedures

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Slide1

Ultrasound Use and Training Available to CRNAs

Dustin Hunter RNAI

Josh Leppert RNAI

Gonzaga University/ Sacred Heart Medical Center

Master of Anesthesiology Education Slide2

Background

The use of ultrasound technology, when performing invasive procedures, is becoming progressively more

prevalent

Ultrasound

technology is rapidly becoming one of the gold standards in delivering safer care when performing invasive

procedures

As our clinical practice evolves, so will the expectations placed on us by patients, surgeons, hospitals, and governing agencies”

(

Pollard, 2011

)Slide3

Statement of the Problem

The improved safety attained with ultrasound is dependent not only on the correct use of ultrasound, but the training and experience of the certified registered nurse anesthetist (CRNA

)

At

present, there are no established standards to ensure proficiency in practice or training of the use of

ultrasound

(Moore, Ding, &

Sadhasivam

, 2012

)Slide4

Purpose Statement

The

purpose of this study, through the use of surveys to CRNAs in Washington, Oregon, Idaho, and Montana, is three-fold:

To identify the prevalence of ultrasound usage during invasive procedures by

CRNAs

To identify the prevalence and types of training CRNAs received to operate

ultrasound

To identify the CRNAs’ sense of the effectiveness of ultrasound

trainingSlide5

Research Questions

What

effect does the use of ultrasound have on patient safety during invasive procedures?

What types of training in the use of ultrasound are being implemented?

What types of comprehensive ultrasound training opportunities are available?

What are the measures of effectiveness in the training of ultrasound?

What are the measures of effectiveness in the use of ultrasound

?

What types of comprehensive ultrasound training opportunities are CRNAs attending?Slide6

Review of the LiteratureSlide7

Safety

The proper use of ultrasound by a skilled provider with training and education can help to minimize the risk of known complications with each

procedure

According to

Narouze

et al 2012, there are no known absolute contraindications to the use of

ultrasoundSlide8

Safety

Landmark

techniques have limitations, as do nerve

stimulators

I

nability

to detect sensitive and key structures may lead to major

complications

Landmark techniques and variations in anatomy

may require the provider to make multiple attempts and needle passes to

achieve blocks or line placement with

limited

accuracySlide9

Safety

With ultrasound, local anesthetic can be

placed directly around the nerve, resulting in faster onset, longer duration and improved quality block using less local anesthetic

(Griffin & Nicholls, 2010)

“Using ultrasound, the volume of local anesthetic is reduced, and general consensus appears to suggest that at least a 50% decrease in volume is common

(

Griffin & Nicholls,

2010)Slide10

Safety

With an aging population presenting with an increasing range of comorbidities, the demand for a broader choice of surgical anesthetic options to provide optimal clinical care with a decreased risk of complications arises. For many of these patients, general anesthesia may prove to be detrimental and therefor the option of regional anesthesia may be the best anesthetic plan. Slide11

Cost Effective

Ultrasound Machine

$

15,000

Average Life Span

5 years

Average Blocks

1,000 per year

$3/block

Money Saved

Average time saved

21 minutes/block

Cost of OR time

$8/min

Cost savings per block $168

Cost savings over 5 years

$840,000Slide12

Cost of a nod of approval from administration

PricelessSlide13

Training

Practitioners using ultrasound without training have been shown to have more complications and lower success

rates

“The major disadvantage often cited is that success is user-dependent, and using ultrasound is a unique skill that requires training and experience to become proficient”

(

Falyar

,

2010)Slide14

Training

Any training is better than no training

2 different strategies to teach UGRA is more effective than using the strategies

separately

(

Gasko

et al.,

2012)Slide15

Training

CME Course on US

Workshops

Books

Internet

YouTube

BlockJock.com

Peer/MentorSlide16

Measures of Effectiveness

Anesthesia professionals should participate in an education program to become competent to use advanced medical technology before using that equipment to care for a patient. A quality educational program will not only include training, but also a means to assess and document

competence.”

(

APSF COT, 2013) Slide17

Measures of Effectiveness

Currently there are NO REQUIRED competencies for US

A

chieving

the goals of improving patient safety, interventional efficacy, and overall patient satisfaction will require the learner to set their own self-directed path towards defining their clinical interests, scope of practice, and skills self-assessment”

(

Pollard, 2011

)Slide18

Methodology

Qualitative Design

Nominal and ordinal data

Survey Monkey

Anonymous electronic survey

Data Analysis

Charts,

Graphs, Cross-tabulations, Free-text

Demographic

CRNAs in WA, OR, ID, and MTSlide19

Findings

106 participants responded to our survey

Areas of practice

55 participants (53%) independent practice

26 participants (25%) medical direction

23 participants (22%) medical supervision

35 participants do not use

ultrasound

71 participants use ultrasoundSlide20
Slide21
Slide22
Slide23

Recommendations

Any training is better than no training

Multiple methods of training is better than a single methodSlide24

Recommendations

We believe that adequate training and access to US ultimately affects the patient and should be a part of every anesthesia provider’s

practiceSlide25

Any Questions?Slide26

References

Anesthesia Patient Safety Foundation. (2013, Winter). Training anesthesia professionals to use advanced medical technology.

Newsletter: The official Journal of the Anesthesia Patient Safety Foundation

,

27, No. 3

, 45-72.

Anesthesia Patient Safety Foundation Committee on Technology. (2013, Winter). Training anesthesia professionals to use advanced medical technology.

APSF NEWSLETTER

,

27, No. 3

, 50-51.

Gasko

, J., Johnson, A. D.,

Sherner

, J., Crag, J.,

Gegel

, B.,

Burgert

, J., ... FRANZEN, 1. (2012, August). Effects of using simulation versus

CD-Rom

in the performance of ultrasound-guided regional anesthesia.

AANA Journal

,

80, No. 4

, S56-S59.

Griffin, J., & Nicholls, B. (2010). Ultrasound in regional anesthesia.

Anaesthesai

Journal of the Association of Anesthetists of Great Britain and Ireland

,

65

(), 1-12. http://

dx.doi.org

/10.111/j.1365-2044.2009.06200.xSlide27

References

Moore, D. L., Ding, L., &

Sadhasivam

, S. (2012). Novel real-time feedback and integrated simulation model for teaching and evaluating ultrasound-guided regional anesthesia skills in pediatric anesthesia trainees.

Pediatric Anesthesia

,

22

, 847-853.

http://

dx.doi.org

/10.1258/ult.2011.011039

Narouze

, S. N.,

Provenzano

, D.,

Peng

, P.,

Eichenberger

, U.,

Chul

Lee, S., Nicholls, B., &

Moriggl

, B. (2012, November-December). The American Society of Regional Anesthesia and

PainMedicine

, the European Society of Regional

Anaesthesiaand

Pain Therapy, and the Asian Australasian

Federationof

Pain Societies Joint Committee Recommendations

foreducation

and training in ultrasound-guided

interventionalpain

procedures.

Regional Anesthesia and Pain Medicine

,

37, Number 6

, 657-664.

Pollard, BSc, MD, MEd, FRCPC, B. A. (2011).

Ultrasound guidance for vascular access and regional anesthesia

. Toronto, Canada: JB Graphics.