Oral Themed Presentation
Context: : Home parenteral nutrition (HPN) programs have been developed to train family members of children with severe digestive diseases including short bowel syndrome. Prior to discharge, families need to learn complex tasks such as CVC care and home parenteral nutrition. Simulation training is rapidly approaching becoming a potential gold-standard for training in healthcare. In 2017, the Boston Children’s Hospital HPN program incorporated a pilot high-fidelity simulation project into an existing multimodal discharge preparedness curriculum including instructional videos, printed handouts, and didactic teaching.
Description: : Data was prospectively collected on families managed at a single HPN program. Participation was voluntary. Experiential learning techniques were implemented (orientation, high-fidelity mannequin, realistic home-like space, structured debriefing). Caregivers completed pre- and post-simulation questionnaires. To address caregivers’ educational goals, simulation engineers and HPN nurses modified clinical scenarios (dressing changes, aseptic needleless change, care and operation of infusion pump and managing medical crisis). HPN nurses worked side-by-side with participants
Observation/Evaluation: : Nineteen families participated with median (interquartile range) of 0.9 (3.7) years, diagnosis of short bowel syndrome in 14 (74%). Participants agreed or strongly agreed with feeling prepared to care for a CVC and set up HPN in 13/14 (93%). Participants requested to focus on the following: HPN set up in 10/14 (74%), dressing change 9/14 (64%), and aseptic needleless change 3/14 (21%). Families independently completed all tasks in the following cases: aseptic needleless change 9/19 (47%), HPN equipment set-up 3/19 (16%), dressing change 7/19 (37%). In the HPN equipment set-up scenario, adding multi-vitamin to HPN was done correctly in 6/19 (32%) cases. Two participants attempted to inject a syringe needle through the plastic flip-top of multi-vitamin vials. Twelve (100%) participants would recommend this learning experience to another parent/caretaker who will be providing CVC and HPN administration to their child.
Discussion: : Family HPN discharge teaching is a novel use for high-fidelity simulation. Families unanimously valued this project. Caregivers fully engaged in the clinical scenarios, because the simulation space was realistic with medical supplies, infusion pumps and bedroom furniture. HPN nursing staff helped make the space safe for learning, and helped families overcome obstacles. Opportunities to improve discharge teaching were identified: Adding multi-vitamins as well as changing dressings (maintaining a sterile field). Next steps are to empower participants to act independently within simulation space, so they can learn by making mistakes. Future studies should also examine the impact of high-fidelity simulation on patient experience and clinical outcomes.