Endoscopy nurse-administered propofol sedation performance. Development of an assessment tool and a reliability testing model

Abstract

Objective. A gold standard of skills required for nurse-administered propofol sedation (NAPS) for gastroenterological endoscopic procedures has been proposed but not established. Due to the potentially hazardous nature of NAPS, an assessment tool is needed to objectively judge the adequacy of training and for future certification. The aim of this study was to develop an assessment tool for measuring competency in propofol sedation and to explore the reliability and validity of the tool. Material and methods. The nurse-administered propofol assessment tool (NAPSAT) was developed in a Delphi-like fashion. Consensus was achieved on 17 items. Validity evidence was gathered in a case-control study in a full-scale simulation setting. Six experienced nurses and six novice nurses were filmed in two scenarios for assessment according to the assessment tool by three content expert raters. Results. A total of 72 NAPSAT assessment forms were analyzed. Inter-rater reliability, Cronbach's α = 0.54 and generalizability coefficient = 0.68. The experienced nurses scored higher than the novices, 52.8 versus 62.7, p = 0.009. The provided pass/borderline/fail assessment showed significant difference, p = < 0.001, Cronbach's α = 0.80, with the novices being more likely to fail and the experienced more likely to pass. Conclusion. Assessing sedation skills in a simulator is possible. Video assessment requires expert knowledge of the procedure and the rating matrix. Overall, NAPSAT showed fair inter-rater reliability and good construct validity. This makes NAPSAT fit for formative assessment and proficiency feedback; however, high stakes and summative assessment cannot be advised.

Key Words::

• education
• endoscopy
• sedation
• simulation
• training

Acknowledgments

The authors thank the Danish Institute for Medical Simulation for providing facilities to conduct this study and Olympus for providing a colonoscope. They also thank A Møller and P Vilmann for assisting in inclusion and logistics and Mette Hyllested for reviewing the assessment tool; Arvid Nilsson's foundation, Torben and Alice Frimodts Foundation, Andersen Isted Foundation, Alfred Helsted and Eli Møllers legate, and Axel Muusfeldts Foundation for financial aid in the conduction of this study. The founders did not have any saying in the conduction or presentation of the study. This work is attributed to gastroenheden D, endoskopi, Herlev Hospital, Copenhagen Denmark.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. Arvid Nilsson's Foundation, Torben and Alice Frimodts Foundation, Andersen Isted Foundation, Alfred Helsted and Eli Møllers legate, and Axel Muusfeldts Foundation financially aided the study. The founders did not have any saying in the conduction or presentation of the study. No competing interests declared.