Impact of a Pediatric Primary Care Office-based Mock Code Program On Physician and Staff Confidence to Perform Life-saving Skills
Impact of a Pediatric Primary Care Office-based Mock Code Program On Physician and Staff Confidence to Perform Life-saving Skills
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基于儿科初级保健办公室的模拟代码计划对医生和工作人员执行救生技能的信心的影响
DOI：
10.1097/01.pec.0000221342.11626.12
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发表时间：
2006
影响因子：
1.4
通讯作者：
E. Reis
中科院分区：
文献类型：
--
作者：
S. Toback;M. Fiedor;Brian Kilpela;E. Reis
背景：以前的研究已经描述儿科办公室对医疗紧急情况准备不足。几十年来，一直在利用儿科“模拟代码”来加强住院医疗单位的应急准备。在实际的复苏过程中，这些练习既能增加从业者的信心，又能减少焦虑。虽然在门诊环境中推荐使用模拟代码，但这些好处尚未被证明是基于办公室的从业者。目的：我们进行了这项研究，以确定在儿科初级保健办公室执行的模拟代码是否增加了医生执行救生技能的信心。方法：儿科组实习医生参加了一项基于办公室的两步应急准备培训的临床试验。首先，医生和工作人员参加了一个1小时的教学项目，其中包括员工教育、办公室应急协议、应急设备和药物，以及制定模拟代码程序的指导方针。其次，每个练习都参加了10-15分钟的模拟代码练习。该演习由儿科高级生命支持教练进行。守则结束后，进行了30分钟的反馈会议，对办公室协调、个人技能表现和复苏方法进行了审查。每个参与的实践还收到了一个婴儿模型和一份文本，其中包含专门为儿科初级保健办公室编写的几个模拟代码场景。干预措施的评估包括两个部分。(1)干预前和干预后完成的一项自我管理调查评估了参与者在紧急情况下的舒适度和执行特定救生技能的信心，采用顺序量表：1 = “非常同意”至5 = “非常不同意”。(2)在培训12个月后，通过电话联系有关做法，以确定它们是否在应急准备方面实施了改进，包括制定模拟代码、编写书面应急规程和购买新的应急设备和药品。结果：参与了11组儿科实践，它们是宾夕法尼亚州西南部城市、郊区和农村办事处的代表。164名医生和工作人员中有97名（59%）完成了干预前和干预后的调查。从业人员被试分为两组进行分析。第一组包括医生、执业护士和医师助理；第二组由注册护士、执业护士和医疗助理组成。比较前与postintervention调查这两个组显示显著改善报告的信心来执行复苏技能包含在培训后的模拟代码:气道定位(组1,67%比94%,P < 0.001;第二组,55%比75%,P = 0.003),呼吸道吸入,(组1,64%比88%,P = 0.005; 2, 27%比51%,P < 0.001),有助于面罩辅助通风(组1,82%比91%,P = 0.003; 2, 39%比71%,P < 0.001)。此外，第1组报告他们对放置骨内线的能力更有信心（24%对39%，P = 0.003），第2组报告他们对给氧的信心显著增加（65%对84%，P < 0.001）。模拟守则的结果是，83%的参与者（包括医务人员和非医务人员）和96%的医生对办公室的医疗紧急情况感到不那么焦虑了。在方案结束12个月后，18%的办公室执行了1个或更多的模拟代码，64%的办公室编写了紧急协议，27%的办公室获得了必要的复苏药物或设备。结论：本研究的结果支持建议，模拟代码应该在儿科初级保健设置，以提高医生的信心和减少医生的焦虑。
Background: Previous studies have described that pediatric offices are ill-prepared for medical emergencies. Pediatric "mock codes" have been utilized to increase the emergency preparedness of inpatient medical units for several decades. These practice drills have been shown to both increase practitioners' confidence and decrease anxiety during actual resuscitations. Although the use of mock codes is recommended in the outpatient setting, these benefits have yet to be demonstrated for office-based practitioners. Objective: We conducted this study to determine whether mock codes performed in pediatric primary care offices increase practitioner confidence to perform life-saving skills. Methods: Pediatric group practices participated in a clinical trial of an office-based, 2-step, emergency preparedness training. First, physicians and staffs attended a 1-hour didactic program which included staff education, office emergency protocols, emergency equipment and medications, and guidelines on instituting a mock code program. Second, each practice participated in a 10-15-minute mock code exercise. The drill was conducted by pediatric advanced life support instructors. After the code, a 30-minute feedback session was conducted which reviewed office coordination, individual skill performance, and approach to resuscitation. Each participating practice also received an infant manikin and a text complete with several mock codes scenarios written specifically for the pediatric primary care office. Evaluation of the intervention consisted of 2 components. (1) Pre- and postintervention completion of a self-administered survey assessed participants' comfort in emergency situations and confidence to perform specific life-saving skills, using an ordinal scale: 1 = "strongly agree" to 5 = "strongly disagree". (2) Practices were contacted by telephone 12 months after the training to determine whether they had implemented improvements in emergency preparedness, including instituting mock codes, preparing a written emergency protocol and purchasing new emergency equipment and medications. Results: Eleven group pediatric practices participated, which were representative of urban, suburban, and rural offices in southwestern Pennsylvania. Ninety-seven of a total 164 (59%) physicians and staff members completed both pre- and postintervention surveys. Practitioner participants were analyzed in 2 groups. Group 1 consisted of physicians, nurse practitioners, and physician assistants; group 2 consisted of registered nurses, licensed practical nurses, and medical assistants. Comparison of pre- versus postintervention surveys in both of these groups revealed significant improvement in reported confidence to perform resuscitation skills that were included in the mock code after the training: airway positioning (group 1, 67% vs. 94%, P < 0.001; group 2, 55% vs. 75%, P = 0.003), airway suctioning, (group 1, 64% vs. 88%, P = 0.005; group 2, 27% vs. 51%, P < 0.001), and bag-mask assisted ventilation (group 1, 82% vs. 91%, P = 0.003; group 2, 39% vs. 71%, P < 0.001). In addition, group 1 reported more confidence in their ability to place an intraossesous line (24% vs. 39%, P = 0.003) and group 2 showed a significant increase in their confidence to administer oxygen (65% vs. 84%, P < 0.001). As a result of the mock code, 83% of all participants, both medical and nonmedical staffs, and 96% of physicians felt less anxious about medical emergencies in the office. Twelve months after the conclusion of the program, 18% of offices had conducted 1 or more mock codes, 64% of offices had written an emergency protocol, and 27% of offices had acquired essential resuscitation medications or equipment. Conclusions: The results of this study support the recommendation that mock codes should be performed in the pediatric primary care setting to improve practitioner confidence and decrease practitioner anxiety.