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Khan EK, Lockspeiser TM, Meier M, Liptzin DR, Baker CD. Improved tracheostomy-dependent patient outcomes after implementation of the Pediatric Resident Education in Pulmonary (PREP) Boot Camp. Pediatr Pulmonol 2024; 59:1388-1393. [PMID: 38372490 DOI: 10.1002/ppul.26925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 02/20/2024]
Abstract
INTRODUCTION Children with tracheostomies are high risk for morbidity and mortality. Pediatric resident physicians are not routinely taught skills to care for this vulnerable patient population. Few reports link educational interventions to improved patient outcomes. This study evaluates the impact of an intensive educational training program on pediatric residents' observed skills and tracheostomy-dependent patient outcomes. METHODS Pediatric post-graduate year 2 (PGY2) resident physicians rotating through the inpatient pediatric pulmonology month at Children's Hospital Colorado July 2018-2019 participated in the Pediatric Resident Education in Pulmonary (PREP) Boot Camp, an intensive educational program with an interactive lecture and simulation experience on patients with tracheostomy-dependence. PGY2s who partook in PREP and PGY3s who rotated before PREP initiation were invited to be studied. Primary outcomes included: (1) resident skills assessed by direct observation during simulation encounters and (2) rates of intensive care unit (ICU) transfers in tracheostomy-dependent patients following acute events before and after introduction of PREP. We hypothesized that increased education would enhance resident skills and improve patient outcomes by decreasing the rate of ICU transfers. RESULTS PGY2 residents retained skills learned during PREP up to 11 months following initial participation, and significantly outperformed their PGY3 counterparts. There was a significant decrease in ICU transfer rate in patients with tracheostomies admitted to the pulmonary team during the 19 months following initiation of PREP. CONCLUSIONS Enhanced early education may improve resident physicians' ability to care for complex patients with tracheostomies and could improve outcomes in this high-risk population.
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Affiliation(s)
- Erin K Khan
- Department of Pediatrics, Division of Allergy, Immunology, Pulmonary and Sleep Medicine, Children's Mercy-Kansas City, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Tai M Lockspeiser
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Maxene Meier
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Deborah R Liptzin
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Christopher D Baker
- Department of Pediatrics, Division of Pulmonology and Sleep Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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Boonjindasup W, Syananondh K, Somboon P, Sritippayawan S. Pediatric Home Tracheostomy Care: The Importance of Knowledge Assessment. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223211061718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Assessment of caregiver knowledge is an essential part of home healthcare education for pediatric tracheostomy care, however, there is a paucity of evidence in long term. This study aims to determine how caregiver knowledge and misconceptions, as assessed by our knowledge test, changed over a 12-month period following our educational program and whether the test score was associated with any demographics of the caregivers and children with tracheostomy. A prospective cohort study was undertaken to evaluate the knowledge at 3 timepoints after tracheostomy education: baseline (T1), 6 months (T2), and 12 months (T3). Test scores were analyzed for trend and relationship with demographics. Items for which less than 80% caregivers gave correct responses at T1 were considered common misconceptions. Fifty-four caregivers were enrolled. Out of a maximum score of 25, the median (IQR) scores were 22 (21-23), 23 (22-24), and 23 (22-25), at T1, T2, and T3, respectively. The scores at T2 and T3 were significantly higher than at T1 ( P ≤ .01). One common misconception “how to manage when suction got less secretion than expected” was found at all timepoints. Caregivers of children with >2 comorbidities scored slightly higher than those of children with 0 to 2 comorbidities ( P = .01). In conclusion, our caregivers achieved high knowledge scores which increased over the 12-month study period potentially because of repeated assessment and practical experience. Common misconceptions and a factor associated with the knowledge were also identified. These advantages highlighted the importance of knowledge assessment for quality improvement.
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Gray M, Bliss DZ, McNichol L. Moisture-Associated Skin Damage: Expanding and Updating Practice Based on the Newest ICD-10-CM Codes. J Wound Ostomy Continence Nurs 2022; 49:143-151. [PMID: 35255065 DOI: 10.1097/won.0000000000000865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Moisture-associated skin damage (MASD) occurs when skin is repeatedly exposed to various sources of bodily secretions or effluents, often leading to irritant contact dermatitis with inflammation, with or without denudation of affected skin. In 2020, the Wound, Ostomy and Continence Nurses Society took an initiative that led to the addition of multiple International Classification for Diseases codes for irritant contract dermatitis caused by various forms of MASD for use in the United States (ICD-10-CM). In the last issue of the Journal of Wound, Ostomy and Continence Nursing, a clinical practice alert identifying the various new codes was published that summarized each of the new codes and provided highlights of the descriptions of each of the these codes. This is the first in a series of 2 articles providing a more detailed description of the newest irritant contact dermatitis codes linked to MASD. Specifically, this article reviews the clinical manifestations and assessment, pathophysiology, epidemiology, prevention, and management of irritant contact dermatitis due to saliva, respiratory secretions, and fecal or urinary incontinence.
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Affiliation(s)
- Mikel Gray
- Mikel Gray, PhD, RN, FNP, PNP, CUNP, CCCN, FAANP, FAAN, Department of Urology, University of Virginia, Charlottesville
- Donna Z. Bliss, PhD, RN, FGSA, FAAN, University of Minnesota School of Nursing, Minneapolis
- Laurie McNichol, MSN, RN, CNS, GNP, CWOCN, CWON-AP, FAAN, WOC Nurse, Cone Health, Greensboro, North Carolina
| | - Donna Z Bliss
- Mikel Gray, PhD, RN, FNP, PNP, CUNP, CCCN, FAANP, FAAN, Department of Urology, University of Virginia, Charlottesville
- Donna Z. Bliss, PhD, RN, FGSA, FAAN, University of Minnesota School of Nursing, Minneapolis
- Laurie McNichol, MSN, RN, CNS, GNP, CWOCN, CWON-AP, FAAN, WOC Nurse, Cone Health, Greensboro, North Carolina
| | - Laurie McNichol
- Mikel Gray, PhD, RN, FNP, PNP, CUNP, CCCN, FAANP, FAAN, Department of Urology, University of Virginia, Charlottesville
- Donna Z. Bliss, PhD, RN, FGSA, FAAN, University of Minnesota School of Nursing, Minneapolis
- Laurie McNichol, MSN, RN, CNS, GNP, CWOCN, CWON-AP, FAAN, WOC Nurse, Cone Health, Greensboro, North Carolina
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Quinton BA, Tierney WS, Bryson PC, Bribriesco A, Gillespie CT, Hopkins BD. An institution-wide tracheostomy rounding team: Initial caregiver perceptions. Am J Otolaryngol 2022; 43:103367. [PMID: 34991021 DOI: 10.1016/j.amjoto.2021.103367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 12/13/2021] [Accepted: 12/18/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To analyze and present the initial findings of provider perceptions regarding the impact of the implementation of a hospital-wide Tracheostomy Rounding Team (TRT) on the delivery of tracheostomy care at the Cleveland Clinic. MATERIALS AND METHODS Based on prior literature, a novel multidisciplinary TRT was designed and implemented at the Cleveland Clinic in December of 2018. After the TRT began clinical care, a previously validated RedCap survey was administered anonymously to 358 caregivers to assess provider experience, comfort, and prior education regarding tracheostomy management. Survey results were collected, and descriptive statistics were applied. Answers were compared between providers who interacted with the TRT clinically and those who did not. RESULTS 42.9% of providers who interacted with the TRT clinically reported that the TRT improved hands-on assistance with tracheostomy care, and 36.7% reported that the TRT improved the identification of safety concerns. Similarly, 34.7% reported that the TRT improved the overall quality of tracheostomy care at the Cleveland Clinic. Providers with active exposure to the TRT additionally reported statistically higher comfort with multiple topics surrounding tracheostomy care. CONCLUSIONS The implementation of this team improved provider comfort in managing patients with tracheostomies both qualitatively and quantifiably. This intervention offered a perceived benefit to patient care at our institution. Further study of the impact of this team on quantitative patient outcomes is forthcoming.
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Affiliation(s)
- Brooke A Quinton
- Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH 44106, USA
| | - William S Tierney
- Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | - Paul C Bryson
- Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | | | - Colin T Gillespie
- Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | - Brandon D Hopkins
- Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, USA..
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Chiang DH, Huang CC, Cheng SC, Cheng JC, Wu CH, Huang SS, Yang YY, Yang LY, Kao SY, Chen CH, Shulruf B, Lee FY. Immersive virtual reality (VR) training increases the self-efficacy of in-hospital healthcare providers and patient families regarding tracheostomy-related knowledge and care skills: A prospective pre-post study. Medicine (Baltimore) 2022; 101:e28570. [PMID: 35029229 PMCID: PMC8757958 DOI: 10.1097/md.0000000000028570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/23/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Virtual reality (VR)-based simulation in hospital settings facilitates the acquisition of skills without compromising patient safety. Despite regular text-based training, a baseline survey of randomly selected healthcare providers revealed deficiencies in their knowledge, confidence, comfort, and care skills regarding tracheostomy. This prospective pre-post study compared the effectiveness of regular text- and VR-based intervention modules in training healthcare providers' self-efficacy in tracheostomy care skills. METHODS Between January 2018 and January 2020, 60 healthcare providers, including physicians, nurses, and respiratory therapists, were enrolled. For the intervention, a newly developed head-mounted display (HMD) and web VR materials were implemented in training and clinical services. Subsequently, in-hospital healthcare providers were trained using either text or head-mounted display virtual reality (HMD-VR) materials in the regular and intervention modules, respectively. For tracheostomy care skills, preceptors directly audited the performance of trainees and provided feedback. RESULTS At baseline, the degree of trainees' agreement with the self-efficacy-related statements, including the aspects of familiarity, confidence, and anxiety about tracheostomy-related knowledge and care skills, were not different between the control and intervention groups. At follow-up stage, compared with the regular group, a higher percentage of intervention group' trainees reported that they are "strongly agree" or "somewhat agree" that the HMD-VR simulation increases their self-efficacy, including the aspects of familiarity and confidence, and reduced their anxiety about tracheostomy-related knowledge and care skills. After implementation, a higher degree of trainees' average satisfaction with VR-based training and VR materials was observed in the intervention group than in the regular group. Most reported that VR materials enabled accurate messaging and decreased anxiety. The increasing trend of the average written test and hands-on tracheostomy care skills scores among the intervention group trainees was significant compared to those in the regular group. The benefits of HMD-VR simulations and web-VR material-based clinical services for in-hospital healthcare providers and patient families persisted until 3 to 4 weeks later. CONCLUSION The current study suggests that VR materials significantly enhance trainees' self-efficacy (increased familiarity, increased confidence, and reduced anxiety) and their satisfaction with the training, while motivating them to use acquired knowledge and skills in clinical practice.
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Affiliation(s)
- Dung-Hung Chiang
- Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, Taipei, Taiwan
- National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-Chang Huang
- Faculty of Medicine, Taipei, Taiwan
- National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Medical Innovation Research Office, Clinical Innovation Center, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shu-Chuan Cheng
- National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Division of Respiratory Therapy, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jui-Chun Cheng
- National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Division of Respiratory Therapy, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Hsien Wu
- Faculty of Medicine, Taipei, Taiwan
- National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shiau-Shian Huang
- Faculty of Medicine, Taipei, Taiwan
- National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Medical Innovation Research Office, Clinical Innovation Center, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ying-Ying Yang
- Faculty of Medicine, Taipei, Taiwan
- National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Medical Innovation Research Office, Clinical Innovation Center, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ling-Yu Yang
- National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shou-Yen Kao
- National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Division of Family Dentistry, Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen-Huan Chen
- National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Fa-Yauh Lee
- National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
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Bernhardt AM, Schlöglhofer T, Lauenroth V, Mueller F, Mueller M, Schoede A, Klopsch C. Prevention and early treatment of driveline infections in ventricular assist device patients – The DESTINE staging proposal and the first standard of care protocol. J Crit Care 2020; 56:106-112. [DOI: 10.1016/j.jcrc.2019.12.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/04/2019] [Accepted: 12/16/2019] [Indexed: 10/25/2022]
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Lawrence PR, Chambers R, Faulkner MS, Spratling R. Evidence-Based Care of Children With Tracheostomies: Hospitalization to Home Care. Rehabil Nurs 2020; 46:83-86. [PMID: 32108728 DOI: 10.1097/rnj.0000000000000254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Routine tracheostomy care in children maintains airway patency, minimizes infection, and ensures skin integrity around the tracheostomy stoma to prevent complications. Using evidence-based recommendations for care of the mature tracheostomy limits variation in practice and leads to better patient outcomes in all care settings. Incorporating evidence-based care into practice is especially important because children with tracheostomies are at high risk for morbidity and mortality. The purpose of this review is to summarize the most current, evidence-based literature for pediatric tracheostomy care, including stoma care and tracheostomy suctioning. Rehabilitation nurses can then include these best practices when caring for children with tracheostomies and when educating caregivers who provide tracheostomy care to children at home.
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Affiliation(s)
- Patricia R Lawrence
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA
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