Practical insights into how one small, well-designed clinical resource improved safety and confidence in a recurring resus challenge.
A highlight from the 2024 APLS PAC Conference in Adelaide.
Speaker biography:
Emily White is a dedicated Registered Nurse with extensive experience at Sydney Children’s Hospital in the Emergency Department since 2016. Throughout her career, Emily has taken on diverse roles, including Clinical Nurse Specialist and Clinical Nurse Educator. Her passion for paediatric emergency care if evident in her commitment to enhancing patient outcomes and mentoring fellow healthcare professionals. Emily brings a wealth of practical knowledge and a compassionate approach to her work, making her a respected leader in paediatric nursing at Sydney Children’s Hospital.
Insights:
(Powered by OpenAI)
- Rising demand for pressor-dose adrenaline revealed inconsistent preparation methods and nurse uncertainty.
- SIM and ACE reviews identified delays, confusion in terminology, and high cognitive load.
- Team created a small “pre-dosed adrenaline box” with four steps, a dilution table, consistent language, and all required equipment.
- Chose a preparation method aligned with RSI practices to maximise familiarity.
- Delivered a standardised lesson plan to 30 nurses, with pre/post surveys and timed audit tools.
- Confidence improved from 17% → 100%, and all timed nurses prepared within <3 minutes.
- Initiative now embedded into study days, SIM, registrar education, and onboarding.
Practical recommendations:
- Cognitive load matters: In high-acuity resuscitation, lack of standardisation directly increases error risk and delays treatment.
- Simulation is an early warning system: Recurrent SIM feedback accurately surfaced workflow and safety problems before major clinical incidents occurred.
- Consistency drives safety: Variability in both dilution method and terminology created confusion; aligning on one method and one language was essential.
- Design familiar, not novel: Adopting a method analogous to the RSI kit improved uptake by leveraging existing muscle memory.
- Education + resource beats education alone: A physical tool with clear instructions dramatically improved confidence and time to drug preparation.
- Measure what matters: Pre/post confidence ratings and timed audit tools provided meaningful, clinically relevant metrics.
Overall: standardisation + cognitive offloading + structured QI + education = improved safety and clinician confidence.