Doctor of Nursing Practice Inquiry Project Report Executive Summary Impact of Surgery Department Mass Casualty Mini Drills on Improvement of Staff Knowledge in a Level 2 Trauma Center: A Pilot Study

. The outcome of an MCI depends upon hospital preparedness (Ben-Ishay, et al., 2016). Several studies described staff disaster training drills as being central to hospital emergency or MCI preparedness (Landman, et al., 2015; Grochtdreis, de Jong, Harenberg, Gorres, & SchroderBack, 2016; Hang, Jianan, & Chunmao, 2016). Yet, less than forty-five percent of rural hospital nurses reported that they felt less than familiar with their disaster preparedness terms and processes; and 40% reported they would be less than effective during an actual disaster (Hodge, Miller, & Dilts Skaggs, 2017). Often, the surgery department staff do not have the opportunity to participate in an MCI drill which may cause variation in how the surgery department responds or performs during a IMPACT OF MASS CASUALTY MINI DRILLS 3 real-life MCI. The standard for frequency of disaster drills in hospitals was established by The Centers for Medicare and Medicaid (CMS). The Emergency Preparedness Rule by CMS (2019) requires hospitals to complete two emergency preparedness training exercise drills a year that include one full community-based drill if possible, and one tabletop drill. However, not every staff member is mandated to participate in each drill, the drills may or may not focus on MCIs, and drills are not required to be specific to the surgery department. The frequency of the surgery department being involved in MCI disaster drills was limited. The surgery department had a full MCI drill in October of 2019 where it was determined that there were opportunities for improvement in MCI response knowledge. Based off that information, the hospital decided to implement routine MCI mini training drills in the surgery department to improve staff knowledge in MCI standard operating procedure. The MCI mini drills are quick and focused drills based upon specific details of a department’s standard operating procedure or hospital policy; and are face-to-face interviews among the participant and the drill leader. Although disaster drills are required by CMS, the literature is scant on the benefits of MCI drills in hospitals on staff knowledge. To enhance knowledge in mass casualty response, the question arose, would mass casualty mini drills in the surgery department impact institutional mass casualty knowledge of policy or procedure? The study aims were: 1. To determine if MCI mini drills have an impact on surgery department staff knowledge of institutional mass casualty policy or procedure over the course of the repeated MCI mini drills using Plan-Do-Study-Act (PDSA) cycles. 2. To correlate the relationship between demographic characteristics and the impact of MCI knowledge improvement. IMPACT OF MASS CASUALTY MINI DRILLS 4 Methodology Study Design This was a pre-intervention (pre-test) and post-intervention (post-test) design. This study was approved by the hospital and Purdue University Institutional Review Boards. Study Procedure Mass casualty incident mini training drills were implemented using PDSA iterative cycles for three months from February 3, 2020 to April 27, 2020, in four 3-week cycles, with surgery staff that were on-duty. A department manager recruited the participants and coordinated the day and time of each mini drill. Each participant for the mini drill was interviewed face-to-face by the same drill leader using an identical 12-item paper questionnaire or instrument which was developed by the author and validated for accuracy based upon the hospital and surgery department MCI policy or procedure. Once the mini drill questionnaire was completed, the drill leader provided immediate feedback with the correct answers to the participant (PDSA action). The drill leader graded the responses. Each question was worth one point and percentage knowledge scores were determined. The interviewer documented the start and stop time of the mini drill, total time for mini drill, and noted whether day or night shift. Study Setting and Population The setting was a 440-bed hospital that was verified as a level 2 Trauma Center with Magnet Nursing Designation in the Midwest. The surgery department consisted of three areas that included the operating room (OR) area, the post-anesthesia care unit (PACU) area, and the pre-post-operative area. Inclusion criteria for the surgery department participants were a) onduty hospital surgery staff who speak English, b) age greater than 17-years old, and c) staff in IMPACT OF MASS CASUALTY MINI DRILLS 5 non-leadership positions. Exclusion criteria were a) non-surgery department staff, b) staff less than 18 years old, c) staff that were not on-duty, d) non-English-speaking staff, and e) staff in leadership positions. The surgery department manager determined the participants based upon the inclusion and exclusion criteria and recruitment materials were not necessary. The participants were classified into two groups, non-previous mini drill (NPMD) participants and previous mini drill (PMD) parti