Interprofessional Patient Simulation Training Compared to Online Training for learning to use In-Line Speaking Valves

Restoring speech in persons who are tracheostomy and ventilator dependent, through the use of a Passy-Muir Speaking Valve (PMSV), requires specific training. Methods of training interprofessional team members to assess in-line PMSVs are unclear. This study used a pretest/ post-test design to compare effects of online training and online training plus simulation training on knowledge acquisition, skills performance, and comfort levels when working with persons who are tracheostomy and ventilator dependent. Twenty-six students studying either respiratory therapy (N=13) or speech-language pathology (N=13) were assigned to the control group or experimental group. Results revealed that online training proved beneficial for increasing tracheostomy and ventilator knowledge. Participants who underwent simulation training reported greater levels of comfort and demonstrated more efficient skills performance during simulation post-testing. Simulation training is efficacious to train interprofessional teams how to properly assess this population for use of in-line PMSVs

Emergency airway and ventilator procedures for community based home care staff validation of an educational program

BackgroundChildren discharged home with tracheostomy and chronic mechanical ventilator support are at high risk for complications and adverse events. Private duty nursing and home respiratory care services are a critical support necessary for successful discharge. The literature suggests that there are opportunities for home care staff (HCS) to improve upon the skills necessary to assess and intervene in an emergency thereby increasing the likelihood of improving long‐term outcomes.MethodsHCS (RN, LPN, RRT) participated in a 4‐h session comprised of lecture and simulation. Lecture content focused on tracheostomy safety, operation of the Trilogy and LTV home ventilators, and review of their common alarms. Simulation included two scenarios simulating tracheostomy decannulation and mucous plugging events. Participant comfort with tracheostomy and ventilator management skills were measured on a five item self‐assessment tool and clinical knowledge was measured using an 11 item multiple choice skills test, both of which were completed before and after the session. We tested to see if there was a change in test scores from pre‐ to post‐intervention.ResultsFifty‐four HCS participated in the program and provided complete data sets. The vast majority (68%) were registered nurses, followed by licensed practical nurses (19%) and respiratory therapists (12%). Participant self‐reported comfort with emergency skills prior to intervention was 3.2/5 which increased to 4.1/5 after intervention (P > 0.0001). Average test score prior to intervention was 62%, post intervention score increased to 82% which represented significant improvement (P > 0.0001).DiscussionHCS are generally unprepared to intervene in an acute airway or ventilator emergency. This short, manageable program provided education that resulted in a significant improvement in both skill level and confidence.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142465/1/ppul23936_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142465/2/ppul23936.pd

Advances in multidisciplinary tracheostomy care and their impact on the safety and quality of care in the critically ill

Tracheostomy is one of the first recorded surgical procedures and refers to an incision into the windpipe at the front of the neck, classically performed by surgeons to relieve airway obstruction. A tracheostomy tube can be inserted to maintain airway patency. The majority of tracheostomies are now performed the critically ill, typically whilst dependent on invasive respiratory support. Analysis of tracheostomy-related critical incidents helped to understand the frequency, nature and severity of problems that can occur at initial placement or during subsequent use. If problems occur, significant harm may rapidly develop, especially in the critically ill. Recurrent themes that contributed to avoidable mortality include poor emergency management and limitations in infrastructure, equipment provision, staff training and education. Many of the problems identified are amenable to prospective, multidisciplinary quality improvement strategies. This thesis describes my published work in this area. An underlying challenge to improving care lies in the fact that care requires input from many clinical disciplines. Complex patients need care in specialised settings that are not always adequately trained and supported in delivering safe tracheostomy care. My research has evaluated the impact of a co-ordinated multidisciplinary approach using bespoke resources, staff education, infrastructure changes and patient champions to direct healthcare improvements. I have critically appraised my bespoke resources and evaluated and justified the use of a variety of quality and safety metrics to define better care, both at patient-level and using institutional process measures, reflecting better coordination of care, contributing to significant cost savings. Further opportunities to build understanding of the nature of tracheostomy problems in ICU and the success of quality improvement initiatives will be discussed. Future aims are to not only improve care but also to perform a detailed economic analysis and capture knowledge on how to best implement necessary changes rapidly in today’s complex NHS

Patient Deterioration Simulation Education and New Graduate Nurses\u27 Self-Confidence and Competence

Inconsistent identification and intervention for patient deteriorations has been identified as a global healthcare issue that has a profound effect on patient outcomes. Failure to rescue (FTR) rates are influenced by the quality of care a hospital provides in the event of patient deterioration. Rapid Response Teams (RRTs) are summoned to the bedside in the event of a patient deterioration to assess the patient and intervene quickly. Efficient use of RRTs prevents cardiopulmonary arrests and decreases hospital mortality, thirty-day morality, and length of stay. Patient deterioration simulation education can improve the use of RRTs and positively influence patient outcomes. New graduate nurses and their preceptors report that new graduate nurses need additional patient deterioration education. A rural community hospital provided patient deterioration simulation education for new graduate nurses in an attempt to improve the utilization of an existing Rapid Response Team and patient outcomes by improving new graduate nurses’ self-confidence and competence. The pre- and post-intervention self-reported self-confidence scores were compared. The scores increased post-intervention, with a large effect size and a clinically significant eta squared value (.48). This pilot project supports further studies exploring new graduate nurses’ self-confidence levels with patient deterioration simulation education

Role of Adaptive Team Coordination during Cardiopulmonary Resuscitation

Plus de 200 000 patients en Amérique du Nord subissent un arrêt cardiaque à l’hôpital chaque année, mais moins de 25 % des patients survivent jusqu’à leur congé de l’hôpital. Lorsque le coeur aux battements arythmiques d’un patient ne parvient pas à faire circuler efficacement le sang, une équipe de secouristes procèdent à des interventions vitales définies en fonction d’algorithmes de réanimation cardiorespiratoire (RCR). Depuis l’adoption des lignes directrices de l’American Heart Association (AHA) il y a plus de 30 ans, les travaux de recherche ont principalement porté sur l’amélioration des taux de survie grâce à l’efficacité des tâches techniques de RCR. Au cours de la dernière décennie, une plus grande importance a été accordée aux facteurs associés à la performance d’équipe. Outre les facteurs propres au patient, les chances de survie dépendent du délai de traitement et de la qualité de la RCR que vient compliquer l’interaction de multiples intervenants qui tentent d’orchestrer des mesures de secours concurrentes. Ainsi, la coordination et le travail d’équipe inefficaces font partir des plus grands obstacles à une réanimation réussie en équipe. Dans le cadre de la présente thèse, la relation entre les différents mécanismes de coordination et le résultat technique de la RCR, mesurée en temps passif dans deux contextes de recherche empirique de réanimation simulée, a été mise à l’essai. Les résultats laissent croire que si l’action explicite constitue la caractéristique déterminante des mécanismes de coordination utilisés en réanimation cardiaque en équipe, les équipes qui performent le mieux coordonnent leurs activités de manière différente de celles qui performent le moins bien, et qu’il existe un lien important entre les tendances en matière de mécanismes de coordination et la réussite de la RCR, qui change en fonction des exigences de la tâche. Ces résultats combinés permettent d’établir un cadre de coordination proposé pour les soins de réanimation actifs et de proposer des aspects pratiques pour la formation en RCR et une contribution méthodologique aux futurs travaux de recherche.In-hospital cardiac arrest affects over 200,000 patients in North America each year, but less than 25% of patients survive to hospital discharge. When a patient’s arrhythmic heart is unable to effectively circulate blood, a team of rescuers provide lifesaving interventions according to Cardiopulmonary Resuscitation (CPR) rescue algorithms. Since the inception of the American Heart Association (AHA) CPR guidelines over 30 years ago, research pursuits to improve survival rates have primarily focused on the technical tasks such as CPR technique. Over the past decade, there has been increased focus on team performance related to treatment delays and CPR quality, touting ineffective coordination and teamwork as some of the largest obstacles to successful team resuscitation. The objective of this work was to validate a proposed framework outlining the relationship among explicit and implicit coordination mechanisms required for successful CPR performance: minimal interruptions (hands-off ratio), rapid initiation of chest compressions and defibrillation. The framework was tested in two independent studies of simulated adult and pediatric resuscitation of in-hospital cardiac arrest. The results showed that while team performance improved over time, the main Explicit and Implicit coordination type patterns were stable. Instead, small shifts occurred within the Information and Action coordination sub-types. Explicit coordination was dominant throughout all resuscitation scenarios, but only Implicit coordination was associated with better hands-off ratio performance. In both studies, higher performing teams coordinated differently than lower performing teams and there was a significant relationship between the patterns of coordination mechanisms and CPR performance. The combined results are used to refine a proposed coordination framework for acute resuscitation care and propose practical implications for CPR training and methodological contribution for future research

DEVELOPMENT OF AN OPTIMAL PATIENT TRANSFER TASK SET AND SIMULATION-BASED INTERVENTION TO REDUCE MUSCULOSKELETAL INJURY IN HEALTHCARE WORKERS

Introduction: Occupational injury is recognized as a key attrition factor in nursing with musculoskeletal injury the most common cause. Nurses, nurse aides and orderly injury rates are consistently listed in the top ten US occupations in terms of total numbers of injuries with patient transfer a primary etiologic factor. Patient transfer education for trainees as well as employees remains inconsistent and non-standardized. Legislative and policy efforts have not been effective.Methods: Two methods are combined in this paper to approach the problem: hierarchical task analysis and a simulation educational intervention. Hierarchical task analysis has been used to solve industrial process problems for more than three decades and simulation education methods have been used in aviation since the 1920's. The hierarchical task analysis process is used to develop an optimal task set which was used to frame and implement a healthcare simulationtraining intervention.Results: Performance evaluation tools for patient transfer were developed based on the optimum task set. Transfer of simulation training outcomes to the clinical setting was demonstrated on pilot study intervention and control units. The program was implemented in a community hospital with sustained improvement in transfer skill and reduction of injury rates and lost work days.Conclusion: Because patient safety and improved outcomes are linked to adequate levels of nurse staffing, the public health implications of this project are significant. If nursing injury can be avoided using these methods then true progress can be made in arresting the injury epidemic with resultant reduction of nursing workforce losses with consequent healthcare system benefits

Neonatal flight safety: northern care outreach

Background and Purpose: Neonatal aeromedical transport is inherently dangerous, (Bouchut, Lancker, Chritin, & Gueugniaud, 2011; Schierholz, 2010), but for Nunavut, Canada, serviced by Keewatin Air, this is the only option to accessing specialized care (McKenzie, 2015). The purpose of this practicum is to support Keewatin Air with a Neonatal Transport Improvement Project (NTIP) to help their staff safely transport neonates. Methods: A needs assessment with Keewatin Air was conducted to determine: 1) neonatal knowledge gaps; 2) relevant primary needs; and 3) resources for continuing education. This writer then consulted with neonatal experts to identify evidence-based recommendations for neonatal transport team training, and how to maintain neonatal safety on transport. Results: Keewatin Air staff identified three primary needs: risk mitigation; improving access to Neonatal Resuscitation Program (NRP); and financial support, and consultation with neonatal experts revealed simulation is the ideal training format. NTIP is presented in two parts: Program Support Presentation, and Simulation Educational Toolkit. The former is a PowerPoint presentation that offers solutions to the identified program needs, and the latter includes the foundations of simulation, educator preparatory material, advice for facilitating effective simulation, and a collection of neonatal simulation scenarios. The simulation toolkit also includes an objective evaluation plan to assess the efficacy of this education. Conclusion: Keewatin Air will now have a toolkit to integrate into their curriculum to improve their medical staff’s neonatal competencies and ultimately neonatal safety during aeromedical transport

Patient Safety and Quality: An Evidence-Based Handbook for Nurses

Compiles peer-reviewed research and literature reviews on issues regarding patient safety and quality of care, ranging from evidence-based practice, patient-centered care, and nurses' working conditions to critical opportunities and tools for improvement