Use of simulation to improve ventricular assist device self-management

使用模拟改善心室辅助装置的自我管理

• 批准号: 9225929
• 负责人: Jeffrey H Barsuk
• 金额: $ 23.53万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-12-09 至 2018-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9225929
• 关键词: Achievement; Advanced Cardiac Life Support; American; Aorta; Blood; Caregivers; Caring; Catheters; Clinical Skills; Competency-Based Education; Complication; Critical Illness; Destinations; Devices; Diagnosis; Education; Educational Curriculum; Emotional; Ensure; Event; Failure; Family; Generations; Heart; Heart Transplantation; Heart Ventricle; Heart failure; Hospitalization; Implant; Infection; Intervention; Interview; Knowledge; Lead; Learning; Left ventricular structure; Life; Maintenance; Malignant Neoplasms; Medical; Methods; Nurses; Operative Surgical Procedures; Outcome; Paracentesis; Patient Care; Patient Education; Patients; Performance; Physicians; Power Sources; Procedures; Process; Pump; Research; Rest; Risk; Safety; Self Management; Signs and Symptoms; Site; Skin; Spinal Puncture; Standardization; Sterile coverings; Sterility; Structure; Supervision; System; Techniques; Technology; Testing; Thrombosis; Time; Training; Transplant Recipients; Transplantation; Venous; base; clinical practice; cost; group intervention; implantable device; implantation; improved; innovation; medical attention; prevent; simulation; skill acquisition; skills; ventricular assist device

Project Summary Over 5.1 million Americans suffer from heart failure (HF), leading to an annual estimated $32 billion societal cost. Although survival from HF has improved, a diagnosis of HF is similar to some forms of cancer, with 50% of patients dying within 5 years. Ventricular assist devices (VADs) have improved survival in patients with advanced HF. Over 17,000 patients with advanced HF received VADs in the last decade. VAD devices are surgically implanted into the heart and provide circulatory support to the patient. A driveline passes from the device through the skin, connecting to a system controller that in turn is connected to a power source. Risks after VAD implantation include life-threatening driveline infections that can lead to device malfunction. At the time of VAD implantation, patients and their caregivers are educated about VAD self-management. After discharge, patients and caregivers are required to engage in daily VAD self-management and recognize VAD-specific signs and symptoms requiring immediate medical attention. With improper VAD self- management, patients can die from preventable complications. Unfortunately, no rigorous standardized training exists for patients and caregivers to ensure mastery of VAD self-management. Traditionally, VAD training consists of patients and their caregivers watching a video or demonstrating VAD-related techniques and then performing these techniques, first under supervision, and within days, independently. This process leads to uneven skill acquisition and may cause unnecessary harm to the patient. Simulation-based mastery learning (SBML) can be used to prevent such uneven skill acquisition and potential patient harm. SBML is an intense form of competency-based education in which learners are required to meet or exceed a predetermined high level of skill on a simulator. Our research demonstrates that SBML is a more effective strategy than traditional education in improving clinical skills and patient care. Therefore, we propose to create and test an SBML intervention for VAD self-management and compare the intervention to traditional (usual) VAD training. Our specific study aims are to: AIM 1. A) Complete semi-structured interviews with nurses, physicians, patients and caregivers to identify common and unique barriers and facilitators encountered regarding VAD self-management. B) Develop an SBML VAD self-management curriculum informed by the interviews and current best practices. AIM 2. Compare performance of VAD self-management skill of sterile dressing changes and VAD-related controller functions between SBML-trained and the usual VAD training group immediately following training, and at one and three months after VAD implantation. AIM 3. This exploratory aim will examine VAD-patient driveline infections, and all-cause and infection-related re-hospitalizations through one and three months after VAD implant, between the SBML intervention group as compared to the usual VAD training group.

项目摘要 超过510万美国人患有心力衰竭(HF)，每年造成约320亿美元的社会损失 成本。尽管心力衰竭的存活率有所提高，但心力衰竭的诊断类似于某些形式的癌症，有50% 在5年内死亡的患者。脑室辅助装置(VAD)可提高脑出血患者的存活率 先进的高频。在过去的十年中，超过17,000名晚期心力衰竭患者接受了VADS治疗。VAD设备是 通过外科手术植入心脏，为患者提供循环支持。一条传动带从 设备通过皮肤连接到系统控制器，而系统控制器又连接到电源。风险 VAD植入后，包括可能导致设备故障的危及生命的传动系感染。 在植入VAD时，患者和他们的照顾者接受关于VAD自我管理的教育。 出院后，患者和照顾者需要进行日常VAD自我管理并认识到 VAD特有的体征和症状需要立即就医。使用不适当的VAD自检 管理方面，患者可能会死于可预防的并发症。 不幸的是，没有为患者和照顾者提供严格的标准化培训来确保掌握VAD 自我管理。传统上，VAD培训包括患者和他们的照顾者观看视频或 演示与VAD相关的技术，然后执行这些技术，首先在监督下进行，然后 在几天内，独立完成。这一过程会导致技能获得不均衡，并可能对 病人。基于模拟的掌握学习(SBML)可以用来防止这种不均衡的技能获得 以及对病人的潜在伤害。SBML是一种强烈的基于能力的教育形式，在这种教育中，学习者 需要在模拟器上达到或超过预定的高技能水平。我们的研究表明 在提高临床技能和病人护理方面，SBML是一种比传统教育更有效的策略。 因此，我们建议创建和测试用于VAD自我管理的SBML干预，并比较 对传统(通常)VAD训练的干预。我们的具体研究目标是： 目标1.a)完成与护士、医生、病人和护理人员的半结构化访谈，以确定 在VAD自我管理方面遇到的共同和独特的障碍和促进者。B)制定一项 SBML VAD自我管理课程从访谈和当前最佳实践中了解到。 目的2.比较无菌换药和VAD相关的VAD自我管理技能的表现 在训练结束后立即在SBML训练组和通常的VAD训练组之间执行控制器功能， VAD植入后1个月和3个月。 目的3.这个探索性目标将检查VAD患者的传动系感染，以及所有原因和感染相关 在植入VAD后1个月和3个月期间，SBML干预组与AS之间再次住院 与通常的VAD训练组相比。