Creation and Validation of a Structured Training Program to Train ICU Nurses in Free Flap Monitoring

Abstract

Abstract Background Monitoring is an important part of the postoperative care of free flap patients. Because the burden of flap examinations often falls to the house staff, residents must make special trips to the hospital for flap examinations, which increases duty hours. We developed a training program designed to train intensive care unit (ICU) nurse to perform significant portion of free flap monitoring. Methods First, ICU charge nurses received a slide presentation and completed an online module to consolidate the didactic training. Second, the nurses were given a written reference manual describing the basic concepts behind free tissue transfer and normal flap physiology. Finally, “on-the-job” training of the nurses was done by residents/house staff. Flap-related outcomes were analyzed. Results The entire group of 24 ICU nurses targeted for this education were successfully trained and transitioned to nurse-led monitoring. For the first 50 patients monitored by ICU nurses following this educational effort, we had no adverse events and no signs of flap compromise were missed by ICU charge nurses. In one instance, an ICU nurse required a resident to personally examine a flap. There were no partial or total flap losses. Conclusions Training of ICU nurses in free flap monitoring can be accomplished through the following principles: (1) leadership and support by the microsurgeons involved; (2) faculty-led didactic and web-based training modules; (3) significant involvement of the otolaryngology house staff; and (4) consistent and experienced ICU nurses in collaboration with nursing leadership. This is the first description of a successfully validated curriculum.

Keywords

• free flap
• monitoring
• flap salvage
• icu nurse