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[Nursing approaches to improve extracorporeal membrane oxygenation (ECMO) care in a pediatric intensive care unit]
Chin-Ling Wu1, I-hsiu Lin, Hsiao-Ping Huang
1Pediatric Intensive Care Unit, Chang Gung Memorial Hospital, Kaohsiung, Taiwan, ROC. bean570@adm.cgmh.org.tw
Insights
Implementing a structured program significantly improved extracorporeal membrane oxygenation (ECMO) care for pediatric patients. This initiative enhanced nursing accuracy, reduced preparation times, and increased overall quality of ECMO services.
Area of Science:
- Critical Care Medicine
- Pediatric Nursing
- Medical Technology Implementation
Context:
- Extracorporeal membrane oxygenation (ECMO) use is increasing in intensive care units.
- Pediatric patients represent a significant subset of ECMO cases.
- Limited nurse experience with ECMO necessitates targeted training and process improvement.
Purpose:
- To enhance the integrity of pre-ECMO order sheets to 98%.
- To reduce ECMO materials preparation time to under 60 minutes.
- To improve nursing cognitive accuracy in ECMO care to 99%.
Summary:
- A dedicated ECMO vehicle, preparation checklist, in-service education, and trainee system were implemented.
- Post-intervention, order sheet accuracy reached 100%, and preparation time decreased from 90 to 40 minutes.
- Nursing cognitive accuracy for ECMO care improved from 51.2% to 99.2%, meeting all objectives.
Impact:
- Enhanced quality of ECMO care for pediatric patients.
- Streamlined ECMO procedures, reducing critical preparation times.
- Improved nursing proficiency and confidence in managing ECMO patients.
Background:
Medical technology advances have led to the increasingly frequent use of extracorporeal membrane oxygenation (ECMO) in intensive care unit applications. Four of the 26 patients treated using ECMO in 2009 at our hospital were under 18 years of age. Limited nurse experience with ECMO and resultant nursing staff nervousness / pressure when using this technique encouraged us to establish an ad hoc group to explore ECMO care and related issues.
Purpose:
Improvement measures were implemented to (1) raise the pre- ECMO placement integrity of order sheets to 98%; (2) reduce materials preparation time to below 60 minutes; and (3) enhance nursing care ECMO cognitive accuracy to 99%.
Resolution:
We implemented the following intervention measures: (1) A dedicated ECMO vehicle was deployed to enhance clinical work convenience and safety; (2) a ECMO technique preparation checklist was developed to improve tubing placement and reduce preparation time; (3) an ECMO care in-service education program was developed to enhance nurses' ECMO care awareness and skills; (4) an ECMO trainee system was established to increase nurses ECMO care experience and reduce negligence-related errors.
Results:
Project results included: material preparation order sheet accuracy rose from 25% to 100%; average materials preparation time fell from 90 to 40 minutes, and nursing staff ECMO cognitive accuracy increased from 51.2% to 99.2%. The program achieved all stated objectives.
Conclusions:
This program enhanced the quality of ECMO care for pediatric patients, reduced materials preparation times, and improved the nursing approach to ECMO care.
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