Hospital to Home: A Quality Improvement Initiative to Implement High-fidelity Simulation Training for Caregivers of Children Requiring Long-term Mechanical Ventilation.
Hospital to Home: A Quality Improvement Initiative to Implement High-fidelity Simulation Training for Caregivers of Children Requiring Long-term Mechanical Ventilation.
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DOI：
10.1016/j.pedn.2017.08.028
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发表时间：
2018-01
期刊：
影响因子：
--
通讯作者：
Baker CD
中科院分区：
文献类型：
--
作者：
Thrasher J;Baker J;Ventre KM;Martin SE;Dawson J;Cox R;Moore HM;Brethouwer S;Sables-Baus S;Baker CD
为需要长期机械通气（LTMV）的儿童家庭做好准备，以管理家中的医疗紧急情况是一项挑战。家庭照顾者在出院前在受控环境中演练危机管理的机会有限。我们的目标是创建一个多模式出院准备课程，结合高保真模拟训练，准备家庭照顾者的儿童复杂的医疗条件，需要长期机械通气。我们试图确定哪些课程元素是最有帮助的，以及该课程是否会影响出院后7天内的再入院率。课程包括教学视频，印刷讲义，心肺复苏术培训，以及两个强制性的高保真模拟场景描述气管切开术和呼吸机相关的紧急情况。每个患者由一到三名家庭护理人员组成的团队管理每种情况。视频汇报侧重于查明和弥补业绩差距。参与者对每个课程元素及其对他们准备出院的相对影响的看法。87名家庭照顾者完成了课程。模拟强化课程深受学员欢迎。参加者报告说，模拟后的情况汇报是最有益的组成部分。我们观察到一个趋势，减少再入院出院后7天内，因为我们修订后的课程实施。模拟训练可纳入需要LTMV儿童家庭的出院训练。在模拟临床环境中演练紧急处理增加了护理人员承担护理呼吸机依赖儿童的信心。
Preparing families of children requiring long-term mechanical ventilation (LTMV) to manage medical emergencies at home is challenging. Opportunities for family caregivers to rehearse crisis management in a controlled setting before discharge are limited. We aimed to create a multimodal discharge preparedness curriculum, incorporating high-fidelity simulation training, to prepare family caregivers of children with complex medical conditions requiring long-term mechanical ventilation. We sought to determine which curricular elements were most helpful and whether this curriculum impacted the rate of readmissions within 7 days of hospital discharge. The curriculum included instructional videos, printed handouts, cardiopulmonary resuscitation training, and two mandatory high fidelity simulation scenarios depicting tracheostomy- and ventilator-related emergencies. Teams of one to three family caregivers per patient managed each scenario. A video-based debriefing focused on identifying and closing performance gaps. Participants rated their perceptions regarding each curricular element and its relative impact on their preparedness for discharge. 87 family caregivers completed the curriculum. Simulation-enhanced curriculum was well-received by participants. Participants reported that post-simulation debriefing was the most beneficial component. We observed a trend toward reduced readmissions within 7 days of discharge since implementation of our revised curriculum. Simulation training can be incorporated into discharge training for families of children requiring LTMV. Rehearsal of emergency management in a simulated clinical setting increases caregiver confidence to assume care for their ventilator-dependent child.
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DOI：
10.1016/j.pedn.2012.10.007
发表时间：
2013-05-01
影响因子：
2.4
作者：
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发表时间：
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期刊：
JOINT COMMISSION JOURNAL ON QUALITY IMPROVEMENT
影响因子：
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