Pediatric Tracheostomy Care Simulation: Real-Life Scenarios in a Safe Learning Environment
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Published on: May 18, 2019
Jennifer L McCoy1, Kathryn A Williams2, Janet L Senkinc3
1Division of Pediatric Otolaryngology, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania. mccoyJL@upmc.edu.
Insights
A simulation program significantly improved caregiver knowledge, confidence, and comfort in managing pediatric tracheostomy patients at home. This training is vital for reducing complications and ensuring better outcomes for medically fragile children.
Area of Science:
- Pediatric critical care
- Medical simulation
- Caregiver education
Background:
- Pediatric tracheostomy is a last resort for airway management, requiring intensive home care due to high risks.
- Tracheostomy complications can lead to significant stress for families.
- High-fidelity simulation aims to mitigate these risks by enhancing caregiver preparedness.
Purpose of the Study:
- To evaluate the effectiveness of a tracheostomy care simulation program for pediatric patients.
- To improve caregiver knowledge, confidence, and comfort in managing tracheostomy-related emergencies at home.
- To reduce morbidity and mortality associated with pediatric tracheostomy discharge.
Main Methods:
- A simulation program using high-fidelity manikins was implemented for caregivers of pediatric tracheostomy patients.
- Pre- and post-program surveys assessed caregiver knowledge, confidence, and comfort.
- Emergency scenarios included tube dislodgement, plugging, cardiac arrest, and ventilator failure.
- Objective data included scenario completion times and prompt rates; chart review assessed readmissions.
Main Results:
- Caregiver scores for knowledge, confidence, and comfort significantly increased post-simulation (P=.001).
- Average total agreement scores rose by 9.1%, with specific gains in knowledge (P=.002), confidence (P=.006), and comfort (P=.01).
- Three out of nine children (33.3%) were readmitted for tracheitis within 90 days.
Conclusions:
- Simulation-based training effectively enhances caregiver preparedness for pediatric tracheostomy care.
- Increased caregiver knowledge, confidence, and comfort are crucial for managing medically fragile children at home.
- Experiencing emergency scenarios firsthand through simulation is vital for preventing adverse events.
Background:
Pediatric patients require tracheostomy tube placement as a last resort for critical airway management. Around-the-clock care is needed at discharge because of the high risk of morbidity and mortality associated with a tracheostomy. The potential for catastrophic sequalae can create a high stress home environment. A simulation program that used a high-fidelity manikin was implemented to reduce complications, morbidity and mortality, and improve skills for real-life medical scenarios.
Methods:
A tracheostomy care simulation program was implemented at a large tertiary care children's hospital from October 2019 to October 2020. Caregivers participated in a pre-post program survey and rated 9 statements on a 5-point scale with regard to knowledge, confidence, and comfort level of taking care of their child at home. Emergency scenarios included accidental tracheostomy tube dislodgement, tracheostomy tube plugging, cardiac arrest, and ventilator failure. Classes were recorded for objective start-to-finish scenario time stamps and prompt rates. A medical chart review was performed 90 d after discharge.
Results:
Eighteen caregivers for 10 children participated. For the 10 children, there was a 9.1% increase in the average total score agreement from pre to post survey, with scores going from "agree" to "strongly agree" (P = .001). Each subset of questions had a significant increase in scores after participation: knowledge, P = .002; confidence, P = .006; and comfort, P = .01. The caregivers required an average 20% prompt rate for the next step in the scenario. Children were 70% female, 80% white, and 60% had public insurance and had their tracheostomy tube placed at a median age of 4 months (range, 0 months to 24 years). Three children (n = 3/9 [33.3%]) were readmitted for tracheitis within 90 d after being discharged to home.
Conclusions:
Caregiver knowledge, confidence, and comfort levels were increased after participation. Pediatric patients with a tracheostomy are medically fragile, therefore, it is important for caregivers to be aware of and prepared for common tracheostomy emergencies and to "experience" emergency situations firsthand.
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