Simulation used to prepare staff for autonomic dysreflexia - VHA SimLEARN
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Simulation used to prepare staff for autonomic dysreflexia

By Yvonne Lin-Chen, RN, MN,
and Anisa Young, BSN, MN, MS, AGCNS-BC, CNRN, CRRN
Nurse Educators/Simulation Lab
VA Puget Sound Health Care System

SEATTLE – Autonomic dysreflexia (AD) is a syndrome that affects an individual with spinal cord injuries at the sixth thoracic (T6) vertebral level or higher. Most AD cases can be treated and prevented if the individual or caregiving team is aware of this syndrome, recognizes the symptoms, understands the causes and implements a treatment algorithm in a timely manner. If untreated, it can become a life-threatening medical emergency with uncontrolled hypertension, as well as lead to severe complications such as seizures, myocardial infarction, cerebral hemorrhage and death.

The Spinal Cord Injury (SCI) unit at the VA Puget Sound Health Care System hosts an annual AD competency fair. In 2017, the unit incorporated simulation into the AD competency fair to achieve the following goals: promptly promote nursing driven AD protocol; orient new hire nurses, which includes new graduate nurses, as well as non-SCI experienced nurses to SCI specific AD management; and create a venue to promote teamwork among new hires and existing staff.

SCI nurse educators and simulation lab nurse educators worked collaboratively to utilize a mannequin to create an AD simulation training: a 30-minute in-person or video-recorded didactic review by SCI physician, Dr. Shawn Song, followed by 15-minute simulation scenarios and 15-minute debriefings.    

Donna Fine, SCI nurse practitioner, and Audrey Thomas, former SCI tele-health coordinator, previously created one of the scenarios. It was modified to match current SCI AD management policy. The scenario involved a 42-year-old Veteran patient who had been posttraumatic for eight months and had a T3 spinal cord injury that he incurred during his service in the Middle East. The patient lost control of his wheel chair in the room and unknowingly broke his right toe. The patient’s baseline blood pressure is normally low around 100’s/60’s mmHg. He was on an intermittent catheterization program and was leaving the bathroom when he injured his toe. The patient had not experienced an AD episode since his initial injury.

In all, 45 staff members received this simulation AD competency renewal training. Learners recognized the patient’s blood pressure was elevated; identified other common AD symptoms such as headache, sweating, bradycardia and anxiety; implemented SCI AD management per policy; and were aware when to notify the physician of unresolved hypertension.

The feedback from learners was positive because of the hands-on experiences and learning, being able to observe a simulated AD episode and being able to work with experienced SCI nurses to see how they respond and take great care of the patient during an AD episode. The SCI unit will continue to utilize this simulation approach and offer other training sessions to support their staff and refresh their knowledge and skills.

REFERENCE:

Solinsky, R., Kirshblum, S. C., & Burns, S. P. (2017). Exploring detailed characteristics of autonomic dysreflexia. The Journal of Spinal Cord Medicine, 1-7.

Solinsky, R., Svircev, J. N., James, J. J., Burns, S. P., & Bunnell, A. E. (2016). A retrospective review of safety using a nursing driven protocol for autonomic dysreflexia in patients with spinal cord injuries. The journal of spinal cord medicine, 39(6), 713-719.