Doctor of Nursing Practice Program

• Committee Chair Name & Credentials:
  K. Melissa Smith Hayes, DNP, ANP-BC, CHFN
• Committee Member Name & Credentials:
  Susanna Rudy, DNP, MSN, MFS, AG-ACNP, FNP-BC, ENP, CCRN

DNP Project Abstract

Point of Care Ultrasound Program Implementation for an Advanced Practice Provider Cohort

Purpose
Point of Care Ultrasound (POCUS) is an emerging field of bedside diagnostics that facilitates provider assessment for life-threatening causes of shock and the response to bedside interventions. As POCUS has become integrated into numerous educational tracks and acute care specialties for physicians, advanced practice providers (APP) currently lack formal guidance from their regulatory bodies on training standards or required training to perform POCUS. The purpose of this project was to implement a 4-hour POCUS training program for the advanced practice provider cohort within a Heart and Vascular Intensive Care Unit (HVICU). This project aims were to increase the APP’s confidence and knowledge of POCUS through the implementation of the POCUS curriculum for the advanced practice provider and serve as a model for future advanced practice cohorts.

Methods
This was an exploratory design quality improvement project. All APPs within the HVICU participated in a 4-hour curriculum during one of three separate educational days (n=11). All participants completed a demographics survey, confidence assessment (11 questions, 5-point Likert scale), and knowledge assessment (20 questions, multiple choice) via REDCap before starting the course. Participants then took part in a didactic session that included ultrasound technology (knobology, physics, equipment, modes of ultrasound), qualitative cardiac and pulmonary POCUS, and the assessment for intra-abdominal free fluid. These topics were then applied to assess clinical syndromes (Cardiac Tamponade, Tension Pneumothorax, Hypovolemia, Pulmonary Embolus/Cor Pulmonale, Aortic Dissection). Lastly, participants practiced POCUS views on a live subject. The class concluded with participants completing the identical confidence and knowledge assessment via REDCap.

Results
POCUS confidence and knowledge were both increased for the APP cohort after course implementation. The cohort’s confidence level mean increased from 1.9 to 3.8 for all POCUS methodology covered. (Likert Scale 1-5 with 1: Not at all confident, 2: Only slightly confident, 3: Somewhat confident, 4: Moderately confident, 5: Very confident). POCUS knowledge increased from a mean of 63.2% to 86.8% for the cohort after course implementation.

Implications for Practice
Implementing a POCUS curriculum for advanced practice providers (APPs) can provide the APP with an educational foundation for basic cardiac and lung ultrasound as well as the assessment of the patient in shock. The results demonstrated that students could become knowledgeable and confident across different applications of POCUS methodology (Cardiac, Pulmonary, Intra-Abdominal exam). Furthermore, learners were then able to combine these applications to assess the patient in shock (Clinical Syndromes of Shock: Tamponade, Tension Pneumothorax, Hypovolemia, Pulmonary Embolus/Cor Pulmonale, Aortic Dissection). Due to the increased utilization of POCUS across acute care settings amongst physician colleagues, APPs should embrace this evolving assessment methodology. The POCUS curriculum evaluated in this project increased both confidence and knowledge for APPs. Similar POCUS curriculum should be utilized to support POCUS education as its usage grows in the critical care arena. Furthermore, this curriculum can serve as a model for future advanced practice cohorts seeking to address the current gap in POCUS education and training.