Traditional Poster Round
Context: : Children in a pediatric intensive care unit (PICU) can have significant morbidity from sedative medications and mechanical ventilation. Early mobilization in the PICU has shown improvement in neurological outcomes of children and reduction in ICU length of stay. (1) However, perceived barriers and safety concerns exist surrounding early mobility in critically ill children including the risk of unplanned extubation, device dislodgement and significant vital sign changes. (2) Even though literature shows a low rate of these adverse events, (3) it is critical that PICU staff and trainee are well trained. This includes utilizing a standard approach towards achieving early mobility ensuring that all the devices and equipment stay in place during mobility. It Is also necessary to develop contingency plans in case an unexpected event occurs while the patient is undergoing rehabilitation therapy. Currently, formal training for early mobility in our PICU does not exist. We developed four simulation scenarios based on potential adverse events related to early mobility in the PICU in order to prepare our staff.
Description: : A Failure Mode Effect Analysis (FMEA) was performed among our early mobility team members to identify the severity, frequency and detectability of complications that may occur during mobility in critical illness. A literature review was also performed to determine the most common and the most serious adverse events that occur during mobilization of critically ill patients. Four simulation scenarios were created based on the FMEA result and literature review. The scenarios include a patient fall, unplanned extubation, staff injury and cardiorespiratory arrest during early mobilization. Physicians, nurses and physical, occupational and respiratory therapists participated in these simulations.
Observation/Evaluation: : A pilot session of these scenarios will be conducted in the winter of 2018. We will conduct regularly scheduled in situ sessions using both standardized patients and simulation mannequins of varying ages. Evaluations of the knowledge, skills and attitudes of these scenarios will be assessed.
Discussion: : We believe that using simulation to assess staff management of adverse events during early mobility will be helpful in improving staff knowledge, skills and attitudes as well as patient safety. We recommend the partnership of FMEA with simulation scenarios be added to the curriculum of staff and trainees for the development of an early mobility program in the PICU. Due to the in-situ nature of these scenarios, we anticipate the need to cancel some of these sessions. We also anticipate finding latent safety concerns that we did not foresee.