Source: http://www.texaschildrens.org/” target=”_blank”>Texas Children’s Hospital
A new, first-of-its-kind program in Texas provided by the Simulation Center at Texas Children’s Hospital will help reassure and prepare parents whose babies are being discharged from the hospital’s neonatal intensive care unit (NICU) on ventilators with tracheostomies. Texas Children’s Hospital cares for babies with complex medical issues such as chronic lung disease from extreme prematurity, which frequently requires mechanical ventilation for long periods of time. Despite needing mechanical ventilation, babies can have a tracheostomy placed, so that they can be sent home safely.
The pilot program, currently in a study phase, was developed to allow parents to practice real-life airway emergency scenarios that can occur when a baby on a ventilator with a tracheostomy is released from the NICU to be cared for at home. The goal of the program is to educate and empower parents to respond skillfully and confidently in a variety of emergency scenarios and to reduce readmissions to the hospital and/or accidental death. Mortality after discharge from the hospital directly associated with airway emergencies ranges between 0.5 and 3 percent in this patient population. Most of these events result from one of two types of airway emergencies: accidental dislodgement or blockage of the tracheostomy tube.
Using a highly technical and realistic manikin that has been modified with a tracheostomy, 10 families have participated in the pilot program which involves practicing four airway emergency scenarios including water dumping from the humidified ventilator circuit into the tracheostomy tube, a tracheostomy tube obstruction, accidental dislodgement of the tracheostomy and what to do in the event of a power failure. The emergency scenarios parents practice in http://www.sim-one.ca/aboutsimone/faqs”>simulation training are based on actual experiences of former Texas Children’s NICU parents after their child was discharged from the hospital. After each simulation scenario, parents receive video-review assisted feedback about their performance during one-on-one debriefing sessions where deviations from expected actions are discussed.
“At Texas Children’s Newborn Center, we discharge between 30 and 50 patients per year who are on ventilators and have tracheostomies and currently, families may not have adequate opportunities to practice responding to emergency medical situations prior to their baby being discharged from the NICU,” said Dr. Jennifer Arnold, Medical Director of Texas Children’s Simulation Center. Although all families receive training on how to care for their baby’s tracheostomy and ventilator, there is no way to give them an opportunity to handle an emergency other than through this type of simulation training. “By training these families in a hands-on way and mimicking real-life scenarios, we are empowering parents and arming them with the skills they need to perform life-saving care if their baby experiences an emergency at home,” said Dr. Arnold.
Drs. Arnold and Shilpa Hundalani, a neonatal intensive care fellow at Texas Children’s Hospital, working closely with NICU discharge coordinators Jenny Gonzales and Heidi Simpson, have now made this training available to all parents at Texas Children’s whose babies and children are being discharged on ventilators and with tracheostomies. They hope the program will be involved in a multi-centre trial so that the work can be of use across the country. “It is crucial to provide this type of training to our high-risk patient population, not only because it’s life-saving but because it’s the baby’s parents who will be administering care and resolving a potential emergency at home until EMS arrives, and they greatly benefit from this hands-on practice,” said Dr. Arnold.
The pilot study was completed in July.