Title : Enhancing nursing nonfidence and competence in managing hypersensitivity reactions through simulation
Abstract:
Outpatient infusion center nurses frequently manage patients receiving high?risk medications associated with hypersensitivity and anaphylactic reactions. Internal assessments across Mayo Clinic Health System (MCHS) Minnesota infusion and oncology sites identified variability in nurses’ confidence and comfort with recognizing reaction severity, initiating appropriate interventions, and applying institutional hypersensitivity and anaphylaxis protocols. In response, a multidisciplinary team developed and implemented a simulation?based educational initiative to address these identified gaps. The purpose of this project was to enhance outpatient infusion nursing staff knowledge, clinical confidence, and competence in recognizing and effectively responding to hypersensitivity and allergic reactions using standardized protocols and emergency procedures. This initiative included a blended educational approach consisting of required pre work (review of the Mayo Clinic Hypersensitivity and Anaphylaxis Treatment RN Protocol, site based emergency procedures, documentation tools, and equipment resources) and hands?on simulation scenarios. Simulations focused on varying severities of hypersensitivity reactions, using a standardized Rituximab infusion scenario to reinforce assessment, medication administration, airway management, escalation of care, and documentation. Participants completed Kirkpatrick Level 1 (pre simulation), Level 2 (post simulation), and Level 3 (90 day post) evaluations to assess learning outcomes and practice impact. Forty four registered nurses completed the pre simulation survey, and 39 completed the post simulation survey. Mean confidence scores improved across all domains, including identification of reaction severity (3.56 to 4.5), medication administration (3.68 to 4.37), initiation of the hypersensitivity and anaphylaxis protocol (3.18 to 4.32), escalation of care (3.66 to 4.34), and documentation in the electronic health record (3.23 to 4.11). Simulation effectiveness received a mean rating of 4.26, and intent to apply learning to practice averaged 4.67.Qualitative responses from the 90 day evaluation demonstrated sustained impact, with participants reporting increased confidence, improved preparedness, clearer understanding of protocol activation, appropriate medication selection, and enhanced documentation practices. Simulation identified system level opportunities, including inconsistent emergency kit nomenclature, protocol lockout timing differences between adult and pediatric protocols, documentation challenges, medication dosing questions, and missing or outdated emergency equipment. These findings informed local practice improvements and contributed to enterprise level protocol review. Simulation based education significantly improved outpatient infusion nurses’ confidence, preparedness, and standardized response to hypersensitivity and anaphylactic reactions. Ongoing protocol refinement and continued experiential learning are essential to sustaining safe, high reliability emergency response practices across ambulatory settings.
