Abstract
Children born with hypoplastic left heart syndrome (HLHS) require multistage surgical palliations to compensate for their undeveloped left ventricle and associated sequelae. The first palliative surgery has the highest mortality risk. These patients are closely monitored once discharged following the first surgery with interstage home monitoring programs. Although providers know these patients are a high-risk population, many inpatient practices do not follow specific precautions during their hospital stay. These patients must maintain balanced circulation. Research has found if systemic vascular resistance is elevated, the patient’s circulation becomes unbalanced, which places them at high risk of sudden death.
The purpose project is to increase nursing knowledge and change current clinical practice by constructing and implementing evidence-based precautions for cardiac shunt–dependent pediatric patients after the first palliative cardiac surgery. This involved nurses and patients in the intensive and cardiac care unit. The precautions will be applied to single ventricle patients with a cardiac shunt. Prior to implementation of the precautions, an educational PowerPoint explaining the physiology of HLHS preoperatively and after the first surgery along with the precautions was mandatory for all nurses and paramedics to complete. After the education, the precautions were implemented with a cardiac shunt dependent precautions sign on applicable patient’s room.
Data was collected for a four-week period, prior to the education, from the electronic medical record regarding times that specific tasks targeted as part of the shunt precautions were performed. These tasks include baths, weights, central line dressing changes, and endotracheal tube retapings. Then, the same data was collected for four weeks, after the educational intervention, to identify a change in practice related to when shunt precaution were initiated. With the implementation of the education, nurses and paramedics working in the pediatric intensive care unit, cardiac step-down unit, cardiac care unit and float pool completed a pre- and posttest to assess an increase in knowledge regarding physiology, systemic vascular resistance, pulmonary vascular resistance, and balanced circulation.
The results did identify a practice change and an increase in knowledge. A paired sample t-test was conducted to compare the pre-educational knowledge and post-educational knowledge (N=126). There was a significant difference in the scores for knowledge from pre- (M=9.25, SD=2.03) to the post-education (M=10.83; SD=2.71) [t(125)=-7.122; p=0.000]. There was also a change in clinical practice regarding nursing tasks targeted by the precautions. Prior to sign implementation, baths were performed at night 59% and post 19%, linen changes 77% pre and post 23%, weights 72% pre and post 39%, ETT retaping 32% pre and post 14%, and dressing changes 37% pre and 25% post.