Award Candidate Poster Presentation

Poster

Simulation based advanced tracheostomy training for home caregivers

Tuesday, May 15
09:45 - 10:45
Location: Neptune 1&2

Abstract : Introduction:
Home caregivers of pediatric tracheostomy patients require extensive training prior to their child’s discharge. We implemented a simulation based pilot program to supplement an established tracheostomy training curriculum. Our goal was to utilize simulation to evaluate home caregivers’ confidence in performing emergent airway scenarios and cardiopulmonary resuscitation (CPR).
Methods:
From October 2016 through October 2017, eligible participants received a comprehensive educational curriculum that included review of a training manual, equipment training, one-on-one training on their child, and a 24-hour supervised family care session where participants demonstrated competence with all aspects of their child’s medical care. After successful completion of this program, we further evaluated participants’ airway management and CPR skills through the use of high-fidelity simulation scenarios that were conducted in a simulated home environment. Scenarios included management of an obstructed airway, accidental decannulation, inability to insert a replacement tracheostomy tube, and CPR. The simulations exposed caregivers to realistic emergencies set in a safe learning environment without risk of patient harm. Debriefing sessions provided an opportunity to reflect on performance while receiving real-time feedback and additional training when necessary. Afterwards, caregivers completed a 10-question survey about their simulation experience.
Results:
Twenty-one home caregivers participated in the pilot program. Survey responses were based on a Likert scale from 1 (strongly disagree) to 5 (strongly agree.) Respondents reported that the simulation improved their ability to recognize obstructive airway and recognize and resolve decannulation with mean Likert scores of 4.6, 4.6 and 4.7 respectively. Additionally, respondents reported that the simulation enhanced their effectiveness as a care provider and helped them feel more prepared to go home with respective mean Likert scores of 4.7 and 4.8.
Conclusion:
Home caregivers reported positive experiences suggesting that simulation provides enhanced preparedness and confidence in the emergent airway management of a child with a tracheostomy. Future work is needed to track the impact that this training has on readmission rates and tracheostomy complication rates. We are also interested in seeing the long term effects this has on home caregivers' confidence in handling tracheostomy emergencies.





Maria Carmen G. Diaz, MD, FAAP, FACEP

Medical Director of Simulation
Nemours Institute for Clinical Excellence, Nemours/Alfred I. duPont Hospital for Children
Wilmington, DE

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Kim Dawson, BSN, RN, CPEN, TCRN, EMT

Simulation Education Specialist
Nemours Institute for Clinical Excellence

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Heather Sobolewski, MSN, RN-BC

Senior Simulation Education Specialist
Nemours Institute for Clinical Excellence

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Jo Hegarty, MD, PhD

Neonatologist
Starship Child Health, Auckland, New Zealand

Dr Jo Hegarty MB BCh BAO, MRCPCH, FRACP, PhD is a Neonatologist at Starship NICU in Auckland, New Zealand and Co-Chair of the IPSS Education Committee. She is a member of the Starship Hospital Simulation faculty and leads the simulation programme in Starship NICU. Recent initiatives include development of a hospital wide ‘hot debriefing’ project and an interdisciplinary ‘difficult conversations workshop’. Her key simulation interests include education, communication and patient safety.

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