| Description |
Background: Procedural training done "on-the-job" can lead to variable learning opportunities and patient outcomes. Inadequately trained providers who perform invasive procedures can negatively impact the cost of care and organizational liability. Institutions must take accountability for training advanced practice clinicians (APCs) to perform invasive procedures based on evidence-based training models and institutional policy if they are expected to perform them regularly in their workflow. Local Problem: On-the-job training is the current training paradigm at this large academic cancer hospital. There is no standardized training on evidence-based procedure instruction, troubleshooting, institutional policy, or potential procedure complications. Methods: This process improvement project developed a structured invasive procedure training program (SIPT) that was evaluated using a pre-post survey approach. Surveys were disseminated to APCs in hematology/BMT and focused on confidence, satisfaction, and self-reported procedure trends pre- and post-intervention. Leadership was surveyed to learn about current training approaches and to gather information to conduct a cost analysis. Post-intervention, APCs and leadership were surveyed to determine the training's usability, feasibility, and satisfaction. Interventions: SIPT was developed and implemented for lumbar punctures, bone marrow and skin biopsies, and Ommaya reservoir access. The program included online training modules focusing on evidence-based procedure instruction, anatomy, institutional policy, troubleshooting techniques, and potential complications. Skills days were conducted as part of the SIPT to provide a low-risk environment for psychomotor skills training. Results: Post-intervention, missed attempt trends were promising (p .01428), and interventional radiology referrals (p .01428) and chemotherapy waste (p .03846) decreased. APCs felt that SIPT was usable, feasible, accessible, and satisfactory. Most APCs (75%) reported improved knowledge of institutional policy and learned troubleshooting strategies. Based on the literature, confidence was not impacted as anticipated. Still, essential trends were identified, including that most APCs had not yet performed or felt they were only novices or competent at performing skin biopsies and Ommaya reservoir access. Conclusion: SIPT is a sustainable, cost-effective option for adjunct training on institutional policy and procedural steps to provide foundational data and refreshers for APCs in hematology/BMT. SIPT can benefit patient-level outcomes such as missed attempts, IR referrals, and chemotherapy waste while providing ongoing training for lower frequency skills such as skin biopsies and Ommaya reservoir access. SIPT is a minimal-risk program with the potential to impact multiple levels, including patients, providers, and the institution. |
