Improving Free Flap Monitoring: Evaluation of a Time-Efficient Educational Nursing Module

SDCC 

Background/Purpose
Postoperative monitoring is vital to allow successful salvage of free flaps when complications arise1. Flap monitoring is not always done by surgeons or those experienced in flap care1. Intensive, in-person in-service modules have demonstrated the ability to improve free flap monitoring knowledge and confidence among nursing staff2. A more succinct learning module that can be completed independently could potentially reach a much larger audience while remaining effective. We conducted a pilot study of an online learning module to improve nursing staff knowledge and confidence regarding free flap monitoring.

Methods and Materials
A HealthStream module about how to monitor and care for free flaps for nurses was assigned to all nurses at a single site. Participants were asked to read a pamphlet and watch an 11-minute video. Participants completed a pre- and post-course survey and quiz to assess comfort level and knowledge, respectively, of free flap monitoring. Pre- and post-course test scores along with participant background information was collected and analyzed.

Results
59 nurses completed our HealthStream module with the pre- and post-course assessments. All nurses work in the PACU with 57 (96.6%) not currently working in the ICU. 39 (66.1%) of participants have been a nurse for at least 10 years, with 24 (40.7%) having been in the ICU for 1 year or less. 40 (67.8%) of the nurses not currently working in the ICU have previous ICU experience. 36 (61%) report taking care of a free flap patient while 22 (37.3%) have not, however, 15 (25.4%) have taken care of a flap patient in the past year while 43 (72.9%) have not. Pre-course comfort monitoring free flaps showed 18 (30.5%) neither comfortable or uncomfortable, 24 (40.6%) uncomfortable, and 16 (27.1%) comfortable. Post-comfort monitoring flaps showed 14 (23.7%) neither comfortable nor uncomfortable, 10 (17%) uncomfortable, and 31 (52.5%) comfortable. On regression, none of the background experience for years as a nurse, in the ICU, and recent or overall free flap monitoring experience was associated with pre-course comfort level (p-value>0.05). Mean quiz scores significantly increased following the module (49.58% vs 100%, p-value<0.001).

Conclusion
Our module provides a quick and time-efficient module for improving comfort level of nurses with monitoring free flaps. Although our module should be applied to other institutions for generalizability, our results could indicate our module as a short module that could potentially increase salvage rates among free flaps that experience complications.

Practice Management

PSTM 2024