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
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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 ultrasoundSlide20Slide21Slide22Slide23
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.