title: Standardization of health care provider competencies for intrathecal access procedures.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors: Duke University Medical Center, Durham, NC, USA mclau002@mc.duke.edu.
authors: Colleen A
authors: CA
authors: McLaughlin
authors: Duke University School of Nursing, Durham, NC, USA.
authors: Marilyn J
authors: MJ
authors: Hockenberry
authors: Duke University School of Medicine, Durham, NC, USA.
authors: Joanne
authors: J
authors: Kurtzberg
authors: Duke University School of Nursing, Durham, NC, USA.
authors: Rémi
authors: R
authors: Hueckel
authors: Duke University School of Medicine, Durham, NC, USA.
authors: Paul L
authors: PL
authors: Martin
authors: Duke University School of Nursing, Durham, NC, USA.
authors: Sharron L
authors: SL
authors: Docherty
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D006282:Health Personnel / Q000193:education* / Q000592:standards*; D006801:Humans; D007278:Injections, Spinal / Q000592:standards*; D010372:Pediatrics / Q000592:standards*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D058996:Quality Improvement / Q000592:standards*
keywords: confirmation bias; diagnostic lumbar puncture; intrathecal chemotherapy; skill decay; therapeutic lumbar puncture