Use of Simulation to Improve Best Practice Mechanical Ventilation

项目摘要 机械通气是一个关键的生命支持治疗的许多最严重和最脆弱的病人， 重症监护室（ICU），但本身可能会造成病人伤害，特别是当最佳做法没有使用。 短期风险，包括发生呼吸机相关性肺炎和呼吸机相关性肺 损伤，以及长期的神经肌肉，精神和认知缺陷，有助于显着 这些患者的死亡率增加了35%。虽然强有力的，以证据为基础的指导方针， 病人的伤害存在，研究表明，医疗界作为一个整体做了非常差的工作，坚持 这对我们的病人是不利的。 有几个原因导致这种不良的坚持，但研究指出，缺乏适当的培训， 知识和技能不足是罪魁祸首。机械通气是一种复杂的治疗方法， 跨专业ICU团队，由医生、护士和呼吸治疗师组成，作为一个 我们认为，旨在减少机械通气可避免的伤害的干预措施必须 解决这个关键问题。我们建议开发和测试一个广泛的，基于模拟的教育课程， 利用先进的病人模拟人体模型，可以与呼吸机在一个现实的互动， 方式我们将进行个人和跨专业团队的培训和评估， 决定我们课程的教育影响。此外，我们还将确定 我们的课程提供最佳实践通风和病人的结果在我们的机构。我们认为 我们可以通过基于模拟的培训计划来影响临床实践，改善患者的治疗效果。

Project Summary Mechanical ventilation is a key life supportive therapy for many of the sickest and most vulnerable patients in the intensive care unit (ICU) but can itself cause patient harm—particularly when best-practices are not used. Short-term risks, including the development of ventilator-associated pneumonia and ventilator-induced lung injury, as well as long-term neuromuscular, psychiatric, and cognitive deficits contribute to the significantly increased mortality of 35% in these patients. Although strong, evidence-based guidelines for the prevention of patient harm exist, studies show that the medical community as a whole does a very poor job adhering to them—to the detriment of our patients. There are several reasons for this poor adherence, but research points to a lack of suitable training and knowledge- and skills-deficits as key culprits. Mechanical ventilation is a complex therapy managed by an interprofessional ICU team, consisting of physicians, nurses, and respiratory therapists, working together as a team, and we believe that interventions aimed at reducing avoidable harm from mechanical ventilation must address this key fact. We propose to develop and test a broad, simulation-based educational curriculum, making use of an advanced patient simulator mannequin that can interact with the ventilator in a realistic manner. We will perform both individual and interprofessional team-based training and assessment to determine the educational impact of our curriculum. Furthermore, we will determine the real-world impact of our curriculum on the delivery of best practice ventilation and patient outcomes at our institution. We believe that we can impact clinical practice with a simulation-based training program, improving patient outcomes.