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Tekin MN, Çobanoğlu N. Management of respiratory problems in children on home invasive mechanical ventilation. Pediatr Pulmonol 2024; 59:2216-2223. [PMID: 38251870 DOI: 10.1002/ppul.26875] [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: 07/30/2023] [Revised: 12/26/2023] [Accepted: 01/11/2024] [Indexed: 01/23/2024]
Abstract
The management of respiratory problems in children on home invasive mechanical ventilation (HIMV) is a complex and challenging task. In recent years, with appropriate family education, these patients have been able to be discharged from the hospital and continue their treatment at home. The population of pediatric patients dependent on HIMV has been increasing worldwide, presenting unique and varying care needs. Management of these patients involves addressing ventilator settings, monitoring respiratory status, ensuring airway safety, and providing continuous support and education to patients and their caregivers. Despite the completion of home settings and family education, children on HIMV may encounter various respiratory problems during home follow-up. Prevention and timely management of these complications are crucial to improving patient outcomes. This article summarizes the most significant respiratory problems in children on HIMV and the management strategies for each problem are discussed, emphasizing the importance of appropriate aspiration techniques, regular monitoring, adequate training of caregivers, and a well-prepared emergency plan.
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Affiliation(s)
- Merve Nur Tekin
- Department of Paediatrics, Division of Paediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Nazan Çobanoğlu
- Department of Paediatrics, Division of Paediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
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Henningfeld J, Friedrich AB, Flanagan G, Griffith C, Hughes A, Molkentine L, Steuart R, Wilkinson S, Baker CD. Transitioning children using home invasive mechanical ventilation from hospital to home: Discharge criteria, disparities, and ethical considerations. Pediatr Pulmonol 2024; 59:2113-2130. [PMID: 38441360 DOI: 10.1002/ppul.26948] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/15/2024] [Accepted: 02/17/2024] [Indexed: 07/27/2024]
Abstract
Children using home invasive mechanical ventilation (HIMV), a valuable therapeutic option for chronic respiratory failure, constitute a growing population. Transitioning children using HIMV from hospital to home care is a complex process that requires a multidisciplinary approach involving healthcare professionals, caregivers, and community resources. Medical stability, caregiver competence, and home environment suitability are essential factors in determining discharge readiness. Caregiver education and training play a pivotal role in ensuring safe and effective home care. Simulation training and staged education progression are effective strategies for equipping caregivers with necessary skills. Resource limitations, inadequate home nursing support, and disparities in available community resources are common obstacles to successful HIMV discharge. International perspectives shed light on diverse healthcare systems and challenges faced by caregivers worldwide. While standardizing guidelines for HIMV discharge may be complex, collaboration among healthcare providers and the development of evidence-based regional guidelines can improve outcomes for children using HIMV and their caregivers. This review seeks to synthesize literature, provide expert guidance based on experience, and highlight components to safely discharge children using HIMV. It further assesses disparities and divergences within regional and international healthcare systems while addressing relevant ethical considerations.
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Affiliation(s)
- Jennifer Henningfeld
- Department of Pulmonary and Sleep Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Annie B Friedrich
- Center for Bioethics and Medical Humanities and Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Grace Flanagan
- Department of Respiratory Care Services, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Cynthia Griffith
- Department of Respiratory Care Services, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Anna Hughes
- Paediatric Respiratory Department, Royal Manchester Children's Hospital, Manchester, UK
| | - Lisa Molkentine
- Department of Respiratory Care Services, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Rebecca Steuart
- Section of Special Needs and Complex Care Program, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Stuart Wilkinson
- Paedaitric Respiratory Department, Royal Manchester Childrens Hospital, Manchester University, Manchester, UK
| | - Christopher D Baker
- Department of Pediatrics-Pulmonary and Sleep Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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Gözetici E, Dönmez H. Digital education-supported telehealth intervention in mothers of children with tracheostomy: A quasi-experimental study. J Pediatr Nurs 2024; 77:e319-e326. [PMID: 38729899 DOI: 10.1016/j.pedn.2024.04.047] [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: 10/05/2023] [Revised: 04/04/2024] [Accepted: 04/26/2024] [Indexed: 05/12/2024]
Abstract
PURPOSE The burden of care is high for parents of children with special care needs. Mothers need to be supported in home care to reduce the burden of care. This study aimed to determine the effects of providing digital education-supported telehealth application to mothers of children with tracheostomy receiving home care on the development of complications, hospital admission, care burden, and knowledge level of mothers. DESIGN AND METHODS A one-group quasi-experimental, pretest-posttest study. The study was conducted with mothers of children with tracheostomy in the pediatric pulmonology outpatient clinic of a university hospital (n = 37). Digital education-supported telehealth application was provided to mothers. The digitally assisted education intervention lasted 6 weeks. Data were collected using the Child and Mother Identification Form, Complication Development Follow-up Form, Hospital Admission Follow-up Form, Caregiver Burden Scale (CBS), and Tracheostomy Care Knowledge Evaluation Questionnaire. The data were collected at three time points: before, immediately after, and 3 months after the education. For data analysis, repeated-measures analysis of variance and the Shapiro-Wilk, Friedman's, and Cochran's Q tests were used. RESULTS In the study, 51% of the mothers were aged between 31 and 40 years; 56% of children were male and 37% were aged ≤3 years. A total of 62% of children aged ≥25 months received respiratory support through home care with tracheostomy and mechanical ventilator. There was no significant difference between the mean number of complications (p = 0.286) and number of hospital admissions (p = 0.079) in the pretest, posttest, and follow-up measurements. The mean CBS score of the mothers decreased in the pretest (36.08 ± 12.04), posttest (33.27 ± 9.58), and follow-up (32.76 ± 11.18) measurements; however, there was no significant difference (p = 0.058). The mean Tracheostomy Care Knowledge Level posttest (13.73 ± 1.28) and follow-up (13.97 ± 1.14) scores increased significantly compared with the pretest (12.14 ± 1.55) scores (p < 0.001). CONCLUSIONS The digital education-supported telehealth application provided to mothers reduced their care burden and increased their knowledge level. There was no change in the number of complications and hospital admissions. PRACTICE IMPLICATIONS Digital education-supported telehealth intervention, applied to parents of children requiring special care, is an effective and easy-to-access nursing intervention in reducing the burden of care.
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Affiliation(s)
- Elif Gözetici
- Sedişehir State Hospital Pediatric Clinic, Konya, Turkey
| | - Hatice Dönmez
- College of Health Science, Karamanoğlu Mehmetbey University, Karaman, Turkey.
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Lambert EM, Ramaswamy U, Gowda SH, Spielberg DR, Hagan JL, Xiao E, Liu S, Villafranco N, Raynor T, Baijal RG. Perioperative and Long-Term Outcomes in Infants Undergoing a Tracheostomy from a Neonatal Intensive Care Unit. Laryngoscope 2024; 134:1945-1954. [PMID: 37767870 DOI: 10.1002/lary.31058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/19/2023] [Accepted: 08/16/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE The purpose of this study was to identify risk factors for perioperative complications and long-term morbidity in infants from the neonatal intensive care unit (NICU) presenting for a tracheostomy. METHODS This single-center retrospective cohort study included infants in the NICU presenting for a tracheostomy from August 2011 to December 2019. Primary outcomes were categorized as either a perioperative complication or long-term morbidity. A severe perioperative complication was defined as having either (1) an intraoperative cardiopulmonary arrest, (2) an intraoperative death, (3) a postoperative cardiopulmonary arrest within 30 days of the procedure, or (4) a postoperative death within 30 days of the procedure. Long-term morbidities included (1) the need for gastrostomy tube placement within the tracheostomy hospitalization and (2) the need for diuretic therapy, pulmonary hypertensive therapy, oxygen, or mechanical ventilation at 12 and 24 months following the tracheostomy. RESULTS One-hundred eighty-three children underwent a tracheostomy. The mean age at tracheostomy was 16.9 weeks while the mean post-conceptual age at tracheostomy was 49.7 weeks. The incidence of severe perioperative complications was 4.4% (n = 8) with the number of pulmonary hypertension medication classes preoperatively (OR: 3.64, 95% CI: (1.44-8.94), p = 0.005) as a significant risk factor. Approximately 81% of children additionally had a gastrostomy tube placed at the time of the tracheostomy, and 62% were ventilator-dependent 2 years following their tracheostomy. CONCLUSION Our study provides critical perioperative complications and long-term morbidity data to neonatologists, pediatricians, surgeons, anesthesiologists, and families in the expected course of infants from the NICU presenting for a tracheostomy. LEVEL OF EVIDENCE 3 Laryngoscope, 134:1945-1954, 2024.
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Affiliation(s)
- Elton M Lambert
- Division of Pediatric Otolaryngology, Derpartment of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A
| | - Uma Ramaswamy
- Division of Pediatric Otolaryngology, Derpartment of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A
| | - Sharada H Gowda
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A
| | - David R Spielberg
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Joseph L Hagan
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A
| | - Emily Xiao
- Baylor College of Medicine, Houston, Texas, U.S.A
| | - Sean Liu
- Department of Anesthesiology, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Natalie Villafranco
- Division of Pulmonary Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A
| | - Tiffany Raynor
- Division of Pediatric Otolaryngology, Derpartment of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A
| | - Rahul G Baijal
- Department of Pediatric Anesthesiology, Perioperative, and Pain Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A
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Foran PL, Benjamin WJ, Sperry ED, Best SR, Boisen SE, Bosworth B, Brodsky MB, Shaye D, Brenner MJ, Pandian V. Tracheostomy-related durable medical equipment: Insurance coverage, gaps, and barriers. Am J Otolaryngol 2024; 45:104179. [PMID: 38118384 PMCID: PMC10939813 DOI: 10.1016/j.amjoto.2023.104179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/05/2023] [Indexed: 12/22/2023]
Abstract
PURPOSE Tracheostomy care is supply- and resource-intensive, and airway-related adverse events in community settings have high rates of readmission and mortality. Devices are often implicated in harm, but little is known about insurance coverage, gaps, and barriers to obtaining tracheostomy-related medically necessary durable medical equipment. We aimed to identify barriers patients may encounter in procuring tracheostomy-related durable medical equipment through insurance plan coverage. MATERIALS AND METHODS Tracheostomy-related durable medical equipment provisions were evaluated across insurers, extracting data via structured telephone interviews and web-based searches. Each insurance company was contacted four times and queried iteratively regarding the range of coverage and co-pay policies. Outcome measures include call duration, consistency of explanation of benefits, and the number of transfers and disconnects. We also identified six qualitative themes from patient interviews. RESULTS Tracheostomy-related durable medical equipment coverage was offered in some form by 98.1 % (53/54) of plans across 11 insurers studied. Co-pays or deductibles were required in 42.6 % (23/54). There was significant variability in out-of-pocket expenditures. Fixed co-pays ranged from $0-30, and floating co-pays ranged from 0 to 40 %. During phone interviews, mean call duration was 19 ± 10 min, with an average of 2 ± 1 transfers between agents. Repeated calls revealed high information variability (mean score 2.4 ± 1.5). Insurance sites proved challenging to navigate, scoring poorly on usability, literacy, and information quality. CONCLUSIONS Several factors may limit access to potentially life-saving durable medical equipment for patients with tracheostomy. Barriers include out-of-pocket expenditures, lack of transparency on coverage, and low-quality information. Further research is necessary to evaluate patient outcomes.
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Affiliation(s)
- Palmer L Foran
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University, Baltimore, MD, United States
| | | | | | - Simon R Best
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University, Baltimore, MD, United States
| | - Sarah E Boisen
- Pediatric Intensive Care Unit, Seattle Children's Hospital, Seattle, WA, United States
| | | | - Martin B Brodsky
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, United States; Department of Physical and Rehabilitation, Johns Hopkins University, Baltimore, MD, United States
| | - David Shaye
- Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School Massachusetts Eye and Ear, United States
| | - Michael J Brenner
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan, Ann Arbor, MI, United States; Global Tracheostomy Collaborative, Raleigh, NC, United States; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Vinciya Pandian
- Center for Immersive Learning and Digital Innovation Johns Hopkins University School of Nursing, Baltimore, MD, United States; Global Tracheostomy Collaborative, Raleigh, NC, United States; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, United States; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States.
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Mirza B, Marouf A, Abi Sheffah F, Marghlani O, Heaphy J, Alherabi A, Zawawi F, Alnoury I, Al-Khatib T. Factors influencing quality of life in children with tracheostomy with emphasis on home care visits: a multi-centre investigation. J Laryngol Otol 2023; 137:1102-1109. [PMID: 36089743 DOI: 10.1017/s002221512200202x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Only a few studies have assessed the quality of life in children with tracheostomies. This study aimed to evaluate the quality of life and the factors influencing it in these children. METHOD This cross-sectional, two-centre study was conducted on paediatric patients living in the community with a tracheostomy by using the Pediatric Quality of Life Inventory. Clinical and demographic information of patients, as well as parents' socioeconomic factors, were obtained. RESULTS A total of 53 patients met our inclusion criteria, and their parents agreed to participate. The mean age of patients was 6.85 years, and 21 patients were ventilator-dependent. The total paediatric health-related quality of life score was 59.28, and the family impact score was 68.49. In non-ventilator-dependent patients, multivariate analyses indicated that social functioning and health-related quality of life were negatively affected by the duration of tracheostomy. The Quality of Life of ventilator-dependent patients was influenced by care visits and the presence of pulmonary co-morbidities. CONCLUSION Children with tracheostomies have a lower quality of life than healthy children do. Routine care visits by a respiratory therapist and nurses yielded significantly improved quality of life in ventilator-dependent children.
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Affiliation(s)
- B Mirza
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah
| | - A Marouf
- Department of Surgery, Otolaryngology - Head and Neck Surgery Section, King Faisal Specialist Hospital and Research Centre, Jeddah
| | - F Abi Sheffah
- Department of Surgery, Otolaryngology - Head and Neck Surgery Section, King Faisal Specialist Hospital and Research Centre, Jeddah
| | - O Marghlani
- Department of Surgery, Otolaryngology - Head and Neck Surgery Section, King Faisal Specialist Hospital and Research Centre, Jeddah
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - J Heaphy
- Department of Surgery, Otolaryngology - Head and Neck Surgery Section, King Faisal Specialist Hospital and Research Centre, Jeddah
| | - A Alherabi
- Department of Surgery, Otolaryngology - Head and Neck Surgery Section, King Faisal Specialist Hospital and Research Centre, Jeddah
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - F Zawawi
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah
| | - I Alnoury
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah
| | - T Al-Khatib
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah
- Department of Surgery, Otolaryngology - Head and Neck Surgery Section, King Faisal Specialist Hospital and Research Centre, Jeddah
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Duggal R, Davis RJ, Appachi S, Tierney WS, Hopkins BD, Bryson PC. Interdisciplinary assessment of tracheostomy care knowledge: An opportunity for quality improvement. Am J Otolaryngol 2023; 44:103865. [PMID: 37004318 DOI: 10.1016/j.amjoto.2023.103865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/19/2023] [Indexed: 04/03/2023]
Abstract
PURPOSE A 2013 AAOHNS consensus statement called for reduced variation in tracheostomy care. Multidisciplinary approaches and standardized protocols have been shown to improve tracheostomy outcomes. This study aims to identify inconsistencies in knowledge in order to design standardized education targeting these areas to improve quality of care. MATERIALS AND METHODS An online, multiple-choice tracheostomy care knowledge assessment was administered to nurses and respiratory therapists in ICUs, stepdown units, and regular nursing floors, as well as residents in otolaryngology, general surgery, and thoracic surgery. The survey was administered and data were recorded using the Select Survey online platform. RESULTS 173 nurses, respiratory therapists, and residents participated in this study. Over 75 % of respondents identified correct answers to questions addressing basic tracheostomy care, such as suctioning and humidification. Significant variation was observed in identification and management of tracheostomy emergencies, and appropriate use of speaking valves. Only 47 % of all respondents identified all potential signs of tracheostomy tube displacement. Respiratory therapists with over 20 years of experience (p = 0.001), were more likely to answer correctly than those with less. Nurses were less likely than respiratory therapists to have received standardized tracheostomy education (p = 0.006) and were less likely than others to choose the appropriate scenario for speaking valve use (p = 0.042), highlighting the need for interdisciplinary education. CONCLUSIONS An interdisciplinary assessment of tracheostomy care knowledge demonstrates variation, especially in identification and management of tracheostomy emergencies and appropriate use of speaking valves. Design of a standardized educational program targeting these areas is underway.
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Affiliation(s)
- Radhika Duggal
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, United States of America.
| | - Ruth J Davis
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Swathi Appachi
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Head and Neck Institute, Cleveland, OH, United States of America
| | - William S Tierney
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Head and Neck Institute, Cleveland, OH, United States of America
| | - Brandon D Hopkins
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Head and Neck Institute, Cleveland, OH, United States of America
| | - Paul C Bryson
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Head and Neck Institute, Cleveland, OH, United States of America
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Duymaz YK, Şahin Ş, Erkmen B, Uzar T, Önder S. Evaluating YouTube as a source of patient information for pediatric tracheostomy care. Int J Pediatr Otorhinolaryngol 2023; 171:111580. [PMID: 37336021 DOI: 10.1016/j.ijporl.2023.111580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/19/2023] [Accepted: 04/29/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES To evaluate YouTube's usefulness as a source of information concerning pediatric tracheostomy care. MATERIALS AND METHODS On August 10, 2022, the top 50 YouTube search results for "pediatric tracheostomy care" were displayed. Each video was evaluated by a jury of three otolaryngologists with at least 2 years of professional experience in pediatric otolaryngology using DISCERN, scoring system of Journal of the American Medical Association (JAMA), and the Global Quality Score (GQS). RESULTS After exclusion criteria 24 videos were evaluated. Fifteen of the evaluated videos were produced by health professionals, and the other nine videos were produced by independent users. The average duration of the videos were 337.5 s, varying between 82 s and 1364 s. The average Discern score of videos produced by health professionals was 38.9 ± 13, compared to 36.6 ± 14 for independent users. The mean JAMA score was 1.04 ± 0.68 for health professionals and 1.11 ± 0.94 for independent users. The GQS score was 2.82 ± 0.73 for health professionals and 3.19 ± 0.84 for independent users. There was no statistically significant difference between the two groups for Discern, JAMA, and GQS scoring. CONCLUSION YouTube does not seem to be a good option for parents to get useful information about pediatric tracheostomy care at this time. Health professionals should provide websites with high-quality materials to improve awareness of pediatric tracheostomy care.
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Affiliation(s)
- Yasar Kemal Duymaz
- University of Health Sciences, Umraniye Training and Research Hospital, Department of Otolaryngology, Istanbul, Turkey.
| | | | - Burak Erkmen
- University of Health Sciences, Sancaktepe Martyr Prof Dr Ilhan Varank Training and Research Hospital Department of Otolaryngology, İstanbul, Turkey.
| | - Tuğçe Uzar
- University of Health Sciences, Umraniye Training and Research Hospital, Department of Otolaryngology, Istanbul, Turkey.
| | - Serap Önder
- Acibadem Ataşehir Hospital, Istanbul, Turkey.
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Poeppelman RS, Coles MT, Heater T, Vohsing L, Von Sadovszky V, Lutmer JE, Maa T. Assessing Competence With a Task Trainer: Validity Evidence for Novel Tracheostomy Care Skills Assessment Tool. Simul Healthc 2022; 17:220-225. [PMID: 34319269 DOI: 10.1097/sih.0000000000000597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The purpose of this study was to develop a caregiver and healthcare provider assessment tool to evaluate essential tracheostomy skills using a simulated task trainer. METHODS Three tracheostomy skill checklists were developed: closed suctioning, open suctioning, and tracheostomy change. Checklist items were developed based on institutional guidelines and a literature review. Items were revised based on iterative expert review and pilot testing. A total of 64 intensive care staff and 24 caregivers were evaluated using the checklists, of which 29 staff members and 4 caregivers were rated simultaneously by 2 raters to estimate interrater reliability. The relationships between checklist performance and staff demographics (experience and discipline) were calculated. A survey examining the selection of automatic fail items and minimum passing score was sent to 660 multidisciplinary staff members. RESULTS Intraclass correlations were 0.93 for closed suctioning, 0.93 for open suctioning, and 0.76 for tracheostomy change. Staff performance only correlated with experience for the tracheostomy change checklist and was inconsistently associated with discipline (respiratory therapy vs nursing). A large, multidisciplinary survey with 132 of 660 respondents confirmed the selection of automatic fail items and minimum passing score. A total of 92.9% of the survey respondents agreed with a minimum passing score of 80%. CONCLUSIONS We developed 3 essential tracheostomy skill checklists with multiple sources of validity evidence to support their use in a simulation-based assessment of tracheostomy skills.
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Affiliation(s)
- Rachel Stork Poeppelman
- From the University of Minnesota Masonic Children's Hospital (R.S.P.), Minneapolis, MN; and Nationwide Children's Hospital (M.T.C., T.H., L.V., V.V.S., J.E.L., T.M.), Ohio State University College of Medicine, Columbus, OH
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Brooks M, Jacobs L, Cazzell M. Impact of emergency management in a simulated home environment for caregivers of children who are tracheostomy dependent. J SPEC PEDIATR NURS 2022; 27:e12366. [PMID: 34923739 DOI: 10.1111/jspn.12366] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/03/2021] [Accepted: 12/08/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Children who are tracheostomy dependent require comprehensive caregiver preparation for safe hospital-to-home transition. Although a structured discharge education program successfully trained caregivers to provide routine daily tracheostomy care, emergency response training was limited, lacking realistic experiences. Initiation of simulated emergency training for caregivers indicated performance confusion related to tracheostomy cardiopulmonary resuscitation (CPR). This study evaluated the effectiveness of an evidence-based tracheostomy CPR education intervention via caregiver participation in a high-fidelity simulation of a home-based emergency scenario on the performance of essential behaviors, comfort, and satisfaction. DESIGN AND METHODS The study utilized a prospective descriptive pre- and post interventional design; 44 caregivers of children who were tracheostomy dependent participated. All caregiver participants completed: video- and instructor-assisted specialized tracheostomy CPR class, high-fidelity simulation performance of a home-based emergency (respiratory failure with cardiac arrest), postsimulation video debriefing, performance assessment with an objective scoring rubric, and pre- and post simulation surveys on levels of comfort and satisfaction. RESULTS On the performance of essential emergency management behaviors, 86.4% of caregivers performed all four behaviors, but only 36.4% performed these essential behaviors in order. Post simulation caregiver comfort with emergency management significantly increased from pre simulation (p = .001). All caregivers were satisfied with this training and would recommend simulation of home-based emergencies for all caregivers. Qualitative feedback from caregivers revealed themes of gratitude and the importance of hands-on practice with guided debriefing/feedback. Study power was 0.98. PRACTICE IMPLICATIONS Objective evaluation of caregiver performance demonstrated specialized tracheostomy CPR education prepared caregivers to respond in a home emergency. Caregivers viewed simulation as an opportunity to gain hands-on experience and improve emergency responses. It may be beneficial for other similar programs to include specialized tracheostomy CPR and emergency scenario simulation in their discharge education protocols and subsequently compare this program to other similar programs to establish best practice guidelines.
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Affiliation(s)
| | - Linda Jacobs
- Cook Children's Medical Center, Fort Worth, Texas, USA
| | - Mary Cazzell
- Cook Children's Medical Center, Fort Worth, Texas, USA
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Antoniou I, Wray J, Kenny M, Hewitt R, Hall A, Cooke J. Hospital training and preparedness of parents and carers in paediatric tracheostomy care: A mixed methods study. Int J Pediatr Otorhinolaryngol 2022; 154:111058. [PMID: 35139446 DOI: 10.1016/j.ijporl.2022.111058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 12/03/2021] [Accepted: 01/25/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Within the UK, the majority of paediatric tracheostomy care is delivered by parents and carers at home. To facilitate this, extensive in-hospital training is delivered by a variety of health care professionals. Our goal was to assess carer perceptions of this process and highlight areas in which we can further improve our service and the training for other hospital providers of paediatric tracheostomy care. METHODS A mixed method approach was adopted. In Phase I, qualitative data from five semi-structured interviews with carers of children with a tracheostomy were thematically analysed and subsequently used to develop a questionnaire. In Phase II, the piloted questionnaire was distributed via telephone, email or post to all eligible caregivers who had been tracheostomy trained at GOSH in the last three years (n = 92). Qualitative and quantitative data were analysed using thematic analysis and descriptive statistics respectively. RESULTS Thirty-five completed questionnaires were received (38% response rate). Overall participants were highly satisfied with the training provided (mean score 8.42 on a scale of 1 (lowest) to 10 (highest)). Carer identified areas requiring improvement were caregiver education pre-tracheostomy; emergency and complication training; supervision and training post hospital discharge; training schedule; emotional support; and support from community healthcare teams. These findings led to multiple subsequent interventions to further improve the carer training programme including training videos, psychology provision on request and increased community training. CONCLUSION Although the evaluation of the service revealed high participant satisfaction in home carer training overall, in-depth analysis of caregivers' experiences indicated common themes in the tracheostomy training service where further support would be beneficial. A carer-centred rather than health professional focus on training needs will allow future attention to be directed to areas of need identified by carers themselves as important to improve the tracheostomy training programme.
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Affiliation(s)
| | - Jo Wray
- Great Ormond Street Hospital, London, UK
| | | | | | | | - Jo Cooke
- Great Ormond Street Hospital, London, UK.
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12
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Hall N, Rousseau N, Hamilton DW, Simpson AJ, Powell S, Brodlie M, Powell J. Impact of COVID-19 on carers of children with tracheostomies. Arch Dis Child 2022; 107:e23. [PMID: 34887248 PMCID: PMC8668410 DOI: 10.1136/archdischild-2021-322979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/24/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To explore the impact of the COVID-19 pandemic on the experiences of caregivers of children with tracheostomies. DESIGN Qualitative semistructured interviews. SETTING All participants were currently, or had previously cared for, a tracheostomised child who had attended a tertiary care centre in the North of England. Health professionals were purposively sampled to include accounts from a range of professions from primary, community, secondary and tertiary care. PARTICIPANTS Carers of children with tracheostomies (n=34), including health professionals (n=17) and parents (n=17). INTERVENTIONS Interviews were undertaken between July 2020 and February 2021 by telephone or video link. MAIN OUTCOME MEASURE Qualitative reflexive thematic analysis with QSR NVivo V.12. RESULTS The pandemic has presented an additional and, for some, substantial challenge when caring for tracheostomised children, but this was not always felt to be the most overriding concern. Interviews demonstrated rapid adaptation, normalisation and varying degrees of stoicism and citizenship around constantly changing pandemic-related requirements, rules and regulations. This paper focuses on four key themes: 'reconceptualising safe care and safe places'; 'disrupted support and isolation'; 'relationships, trust and communication'; and 'coping with uncertainty and shifting boundaries of responsibility'. These are described within the context of the impact on the child, the emotional and physical well-being of carers and the challenges to maintaining the values of family-centred care. CONCLUSIONS As we move to the next phase of the pandemic, we need to understand the impact on vulnerable groups so that their needs can be prioritised.
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Affiliation(s)
- Nicola Hall
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Nikki Rousseau
- Surgical, Diagnostic and Devices Division, University of Leeds, Leeds, UK
| | - David W Hamilton
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - A John Simpson
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Steven Powell
- Department of Paediatric Otolaryngology, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Malcolm Brodlie
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Department of Paediatric Respiratory Medicine, Great North Children's Hospital, Newcastle Upon Tyne, UK
| | - Jason Powell
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Department of Paediatric Otolaryngology, Great North Children's Hospital, Newcastle upon Tyne, UK
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13
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Smith S, Tallon M, Clark C, Jones L, Mörelius E. "You Never Exhale Fully Because You're Not Sure What's NEXT": Parents' Experiences of Stress Caring for Children With Chronic Conditions. Front Pediatr 2022; 10:902655. [PMID: 35832577 PMCID: PMC9271768 DOI: 10.3389/fped.2022.902655] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
Children with chronic conditions are experiencing improved survival worldwide, and it is well-known that their parents are stressed. Yet, despite this knowledge, parents continue to experience stress. Our study explored the lived experience of parental stress when caring for children with various chronic conditions to identify opportunities to potentially reduce stress for these parents. This was an exploratory qualitative study using semi-structured interviews. To ensure appropriate research priorities were addressed, the study was co-designed with consumer and stakeholder involvement. Twenty parents were interviewed. Parents were recruited through a recognized family support organization for children with various care needs in Western Australia. Interviews were audio-recorded, transcribed verbatim, anonymized, and analyzed using Interpretative Phenomenological Analysis. Two superordinate themes were identified: (1) Gut instinct to tipping point included parents as unheard experts and their experiences of stress and becoming overwhelmed. (2) Losses and gains covered the parents' identity and relationship challenges and coping strategies with their children's unpredictable conditions. Parents' experiences of stress caring for children with chronic conditions can be applied to the Job-Demand Control-Support Model for occupational stress. Not only does this application provide a useful framework for practitioners but it adds a unique perspective that reflects the dual role of parents in caring for their children with chronic conditions as a parent but also a professional with a 24/7 workload. The parents' experiences highlight a need for improved support access, effective communication between parents and health care professionals, discharge preparation and information provision, and regular screening of parental stress with a referral pathway.
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Affiliation(s)
- Stephanie Smith
- School of Nursing and Midwifery, Edith Cowan University, Joondaulup, WA, Australia.,Perth Children's Hospital, Nursing Research Department, Nedlands, WA, Australia
| | - Mary Tallon
- School of Nursing, Curtin University, Bentley, WA, Australia
| | - Carrie Clark
- Kalparrin, Perth Children's Hospital, Nedlands, WA, Australia
| | | | - Evalotte Mörelius
- School of Nursing and Midwifery, Edith Cowan University, Joondaulup, WA, Australia.,Perth Children's Hospital, Nursing Research Department, Nedlands, WA, Australia
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14
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Yilmaz Yegit C, Kilinc AA, Can Oksay S, Unal F, Yazan H, Köstereli E, Gulieva A, Arslan H, Uzuner S, Onay ZR, Kilic Baskan A, Collak A, Atag E, Ergenekon AP, Bas Ikizoğlu N, Ay P, Oktem S, Gokdemir Y, Girit S, Cakir E, Uyan ZS, Cokugras H, Karadag B, Karakoc F, Erdem Eralp E. The ISPAT project: Implementation of a standardized training program for caregivers of children with tracheostomy. Pediatr Pulmonol 2022; 57:176-184. [PMID: 34562057 DOI: 10.1002/ppul.25704] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/15/2021] [Accepted: 09/15/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Tracheostomy-related morbidity and mortality mainly occur due to decannulation, misplacement, or obstruction of the tube. A standardized training can improve the skills and confidence of the caregivers in tracheostomy care (TC). OBJECTIVE Our primary aim was to evaluate the efficiency of standardized training program on the knowledge and skills (changing-suctioning the tracheostomy tube) of the participants regarding TC. MATERIALS AND METHODS Sixty-five caregivers of children with tracheostomy were included. First, participants were evaluated with written test about TC and participated in the practical tests. Then, they were asked to participate in a standardized training session, including theoretical and practical parts. Baseline and postintervention assessments were compared through written and practical tests conducted on the same day. RESULTS A significant improvement was observed in the written test score after the training. The median number of correct answers of the written test including 23 questions increased 26%, from 12 to 18 (p < .001). The median number of correct steps in tracheostomy tube change (from 9 to 16 correct steps out of 16 steps, 44% increase) and suctioning the tracheostomy tube (from 9 to 17 correct steps out of 18 steps, 44% increase) also improved significantly after the training (p < .001, for both). CONCLUSION Theoretical courses and practical hands-on-training (HOT) courses are highly effective in improving the practices in TC. A standardized training program including HOT should be implemented before discharge from the hospital. Still there is a need to assess the impact of the program on tracheostomy-related complications, morbidity, and mortality in the long term.
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Affiliation(s)
- Cansu Yilmaz Yegit
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Ayse Ayzit Kilinc
- Division of Pediatric Pulmonology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Sinem Can Oksay
- Division of Pediatric Pulmonology, Istanbul Medeniyet University, Faculty of Health Sciences, Istanbul, Turkey
| | - Fusun Unal
- Division of Pediatric Pulmonology, Istanbul Medipol University, School of Medicine, Istanbul, Turkey
| | - Hakan Yazan
- Division of Pediatric Pulmonology, Istanbul Bezmialem University, School of Medicine, Istanbul, Turkey
| | - Ebru Köstereli
- Division of Pediatric Pulmonology, Koc University, School of Medicine, Istanbul, Turkey
| | - Aynur Gulieva
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Hüseyin Arslan
- Division of Pediatric Pulmonology, Istanbul Medipol University, School of Medicine, Istanbul, Turkey
| | - Selçuk Uzuner
- Division of Pediatrics, Istanbul Bezmialem University, School of Medicine, Istanbul, Turkey
| | - Zeynep Reyhan Onay
- Division of Pediatric Pulmonology, Istanbul Medeniyet University, Faculty of Health Sciences, Istanbul, Turkey
| | - Azer Kilic Baskan
- Division of Pediatric Pulmonology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Abdulhamit Collak
- Division of Pediatrics, Istanbul Bezmialem University, School of Medicine, Istanbul, Turkey
| | - Emine Atag
- Division of Pediatric Pulmonology, Istanbul Medipol University, School of Medicine, Istanbul, Turkey
| | - Almala Pinar Ergenekon
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Nilay Bas Ikizoğlu
- Division of Pediatric Pulmonology, Sureyyapasa Chest Diseases and Thoracic Surgery Training Hospital
| | - Pinar Ay
- Division of Public Health, Marmara University, School of Medicine, Istanbul, Turkey
| | - Sedat Oktem
- Division of Pediatric Pulmonology, Istanbul Medipol University, School of Medicine, Istanbul, Turkey
| | - Yasemin Gokdemir
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Saniye Girit
- Division of Pediatric Pulmonology, Istanbul Medeniyet University, Faculty of Health Sciences, Istanbul, Turkey
| | - Erkan Cakir
- Division of Pediatric Pulmonology, Istanbul Bezmialem University, School of Medicine, Istanbul, Turkey
| | - Zeynep Seda Uyan
- Division of Pediatric Pulmonology, Koc University, School of Medicine, Istanbul, Turkey
| | - Haluk Cokugras
- Division of Pediatric Pulmonology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Fazilet Karakoc
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Ela Erdem Eralp
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
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15
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Ahmed ST, Yang C, Deng J, Bottalico DM, Matta-Arroyo E, Cassel-Choudhury G, Yang CJ. Implementation of an Online Multimedia Pediatric Tracheostomy Care Module for Healthcare Providers. Laryngoscope 2021; 131:1893-1901. [PMID: 33459406 DOI: 10.1002/lary.29400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 12/10/2020] [Accepted: 01/04/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate the effect of a multimedia educational module on provider attitudes toward pediatric tracheostomy care. We also describe the process of module development and dissemination at an academic children's hospital. STUDY DESIGN Prospective observational study. METHODS The pediatric airway committee at an urban tertiary care center developed a multimedia pediatric tracheostomy care module. Nurses, respiratory therapists, as well as resident, fellow, and attending physicians caring for pediatric patients with tracheostomies were eligible. Managers and clinical supervisors from various units recruited participants to complete the pediatric tracheostomy care electronic module and pre- and postassessment knowledge quizzes and surveys. Provider confidence was analyzed using Kruskal-Wallis H-test and Mann-Whitney U-test, and paired t-test was used to compare pre- and postmodule quiz scores. RESULTS A total of 422 participants completed the module. A total of 275 participants completed the premodule survey, 385 completed the premodule quiz, 253 completed the postmodule survey, and 233 completed the postmodule quiz. Participants included providers in the neonatal intensive care unit, pediatric intensive care unit, pediatric emergency department, and pediatric wards. Postmodule surveys demonstrated a significant reduction in the average percentage of participants indicating lack of confidence with regards to changing an established tracheostomy, responding to accidental decannulation of established tracheostomy, and responding to accidental decannulation of fresh tracheostomy (P < .001). Average quiz scores increased by 5.6 points from 83.0% to 88.6% (P < .00001). CONCLUSIONS A multimedia educational module can improve provider perception of their knowledge and confidence surrounding pediatric tracheostomy management. LEVEL OF EVIDENCE 3 Laryngoscope, 131:1893-1901, 2021.
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Affiliation(s)
- Sadia T Ahmed
- Albert Einstein College of Medicine, Bronx, New York, U.S.A
| | - Catherina Yang
- Department of Otorhinolaryngology, Montefiore Medical Center, Bronx, New York, U.S.A
| | - Junwen Deng
- Albert Einstein College of Medicine, Bronx, New York, U.S.A
| | - Danielle M Bottalico
- Department of Otorhinolaryngology, Montefiore Medical Center, Bronx, New York, U.S.A
| | - Esther Matta-Arroyo
- Division of Respiratory and Sleep Medicine, Children's Hospital at Montefiore, Bronx, New York, U.S.A
| | - Gina Cassel-Choudhury
- Albert Einstein College of Medicine, Bronx, New York, U.S.A.,Division of Pediatric Critical Care Medicine, Children's Hospital at Montefiore, Bronx, New York, U.S.A
| | - Christina J Yang
- Albert Einstein College of Medicine, Bronx, New York, U.S.A.,Department of Otorhinolaryngology, Montefiore Medical Center, Bronx, New York, U.S.A
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16
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Promoting parental education of infants hospitalized in a children's hospital in Tabriz, Iran: a best practice implementation project. JBI Evid Implement 2020; 19:288-295. [PMID: 34491924 DOI: 10.1097/xeb.0000000000000259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Parents of infants admitted to hospital have high information needs. A good educational program will improve the outcomes and communication needs of these parents. Results from some studies have shown that patient education in Iran is inappropriate and should be improved. OBJECTIVES The aim of this evidence implementation project was to evaluate the current practice and implement the best practice related to promoting patient education in a children's hospital in Tabriz, Iran. METHODS A clinical audit was undertaken using the Joanna Briggs Institute Practical Application of Clinical Evidence System tool. Eight audit criteria that represent the best practice recommendations for patient education were used. A baseline audit was conducted followed by implementing multiple strategies, and the project was finalized with a follow-up audit to determine a change in practice. RESULTS Significant improvements in the follow-up audit in comparison with the baseline audit were as follows: evaluation of patient learning has been undertaken to determine met and unmet needs (from 65 to 77%); patients' learning needs, readiness to learn, and their learning style have been assessed before the implementation of an educational initiative (from 55 to 66%); and educational resources in different formats (e.g., written handouts, brochures, and links to online materials) are available in the ward (from 33 to 77%). Strategies that were implemented to achieve change in practice included conducting workshops and conferences, determining a trained nurse as responsible for educating parents, training in discharge time, the presentation of educational films daily, conducting group training, and installing related posters in the department and patient's room. The other five criteria were less compliant with best practice in the follow-up audit rather than the baseline audit; however, all of them except one (Criterion 3) were still up to 75% compliant, which is considered excellent by the audit team. CONCLUSION The follow-up audit results indicated an improvement in providing parental education. It can be concluded that these interventions can facilitate the implementation of evidence into clinical practice.
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Mai K, Davis RK, Hamilton S, Robertson-James C, Calaman S, Turchi RM. Identifying Caregiver Needs for Children With a Tracheostomy Living at Home. Clin Pediatr (Phila) 2020; 59:1169-1181. [PMID: 32672065 DOI: 10.1177/0009922820941209] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study sought to understand caregiver needs of children with tracheostomies (CWT) living at home and inform development of standardized tracheostomy simulation training curricula. Long-term goals are decreasing hospital readmissions following tracheostomy placement and improving family experiences while implementing a medical home model. We recruited caregivers of CWT and conducted semistructured interviews, subsequently recorded, transcribed, and analyzed for emerging themes using NVivo. Demographic data were collected via quantitative surveys. Twenty-seven caregivers participated. Emerging themes included the following: (1) caregivers felt overwhelmed, sad, frightened when learning need for tracheostomy; (2) training described as adequate, but individualized training desired; (3) families felt prepared to go home, but transition was difficult; (4) home nursing care fraught with difficulty and yet essential for families of CWT. Families of CWT have specific needs related to discharge training, resources, support, and home nursing. Provider understanding of caregiver needs is essential for child well-being, patient-/family-centered care, and may improve health outcomes.
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Affiliation(s)
- Katherine Mai
- Drexel University, Philadelphia, PA, USA.,St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | | | - Sue Hamilton
- St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | | | - Sharon Calaman
- St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Renee M Turchi
- Drexel University, Philadelphia, PA, USA.,St. Christopher's Hospital for Children, Philadelphia, PA, USA
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18
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Lemos HJMD, Mendes-Castillo AMC. Social support of families with tracheostomized children. Rev Bras Enferm 2019; 72:282-289. [DOI: 10.1590/0034-7167-2018-0708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 03/02/2019] [Indexed: 02/17/2023] Open
Abstract
ABSTRACT Objective: To understand the social support of families with tracheostomized children. Method: Qualitative study using the Model of Dimensions of Social Support together with the Family System-Illness model as theoretical frameworks, based on the hybrid model of thematic analysis. Nine families with tracheostomized children were interviewed in an outpatient pediatric otorhinolaryngology department of a public hospital in the inner state of São Paulo. Results: The experience of social support to each phase of the family experience was presented in three themes: “Knowing the need for a tracheostomy”, “Performing a tracheostomy” and “Living with a tracheostomy”. Final considerations: Understanding how the experience of social support occurs can support assessment and intervention strategies, aiming to meet the demands of the family at each phase of its trajectory, collaborating for a continuous and integral nursing care.
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19
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Benscoter D, Borschuk A, Hart C, Voos K. Preparing families to care for ventilated infants at home. Semin Fetal Neonatal Med 2019; 24:101042. [PMID: 31648918 DOI: 10.1016/j.siny.2019.101042] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Advances in neonatal care have led to increased survival of infants with complex medical needs and technology dependence. Transition of the ventilator-dependent infant from hospital to home is a complex process that requires extensive coordination between the medical team and family. Home caregivers must be prepared to provide routine care for the ventilator-dependent child and respond to life-threatening emergencies. Families should be counseled on the need for home nursing, medical equipment and an adequate home environment to ensure a safe transition to home. Throughout the process, the family may require financial, social and psychological support. A structured education and transition process that is clearly communicated to parents is necessary to have an effective partnership with families.
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Affiliation(s)
- Dan Benscoter
- Department of Pediatrics, University of Cincinnati, College of Medicine, 3333 Burnet Ave, Cincinnati, 45229, OH, USA; Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, 45229, OH, USA.
| | - Adrienne Borschuk
- Department of Pediatrics, University of Cincinnati, College of Medicine, 3333 Burnet Ave, Cincinnati, 45229, OH, USA; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, 45229, OH, USA.
| | - Catherine Hart
- Department of Otolaryngology, University of Cincinnati, College of Medicine, 231 Albert Sabin Way, Cincinnati, 45267, OH, USA.
| | - Kristin Voos
- Department of Pediatrics, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, 44106, OH, USA; Division of Neonatology, University Hospitals Cleveland Medical Center Rainbow Babies and Children's Hospital, 11100 Euclid Ave, Cleveland, 44106, OH, USA.
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20
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Abstract
Neonatal and infant tracheostomies have been valuable in the care and survival of children over the past century. With the implementation of neonatal and pediatric intensive care units, more infants are surviving conditions that were considered fatal. Neonatal tracheostomy plays a vital role in many of these conditions, with significant implications and association with overall mortality, morbidity, and developmental outcomes. Although the technique has not changed much, there have been significant evolutions in indications, survival, complications, and technological advances. Improved outcomes research to decrease the high associated morbidities is needed.
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Affiliation(s)
- Jonathan Walsh
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins School of Medicine, 601 North Caroline Street, 6th Floor, Baltimore, MD 21287, USA.
| | - Jeffrey Rastatter
- Ann & Robert H. Lurie Children's Hospital of Chicago, Box 25, 225 E Chicago Avenue, Chicago, IL 60611, USA
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21
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Abstract
Families experience many psycho-social challenges when caring for a child with a tracheostomy in the home. The support of a Medical Social Worker in a Pediatric Aero-digestive Program is vitally important to help families navigate the multiple systems required to help manage the needs of medically complex child. The Medical Social Worker should strive to partner with families to provide resources and coordinate care to enhance coping and improve overall patient care and well-being.
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22
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Pozzi M, Galbiati S, Locatelli F, Clementi E, Strazzer S. Performance of a tracheostomy removal protocol for pediatric patients in rehabilitation after acquired brain injury: Factors associated with timing and possibility of decannulation. Pediatr Pulmonol 2017; 52:1509-1517. [PMID: 28950420 DOI: 10.1002/ppul.23832] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 09/01/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVES We assessed the performance of a tracheostomy decannulation protocol privileging safety over quickness, in pediatric patients undergoing rehabilitation from severe acquired brain injury. We analyzed factors associated with decannulation timing and possibility and examined cases of failure. HYPOTHESIS A safe decannulation protocol should minimize failures. STUDY DESIGN Retrospective observational study. PATIENT SELECTION Patients aged 0-17 admitted to rehabilitation with tracheostomy in the last 15 years (n = 123). METHODOLOGY We collected data on clinical and respiratory conditions at admittance, during the first rehabilitation stay and following follow-up controls. We described the sample and tested associations of several factors with the possibility to decannulate patients during either the first stay or follow-up. We described failures, defined as the cases in which tracheostomy tube had to be placed back immediately or after less than 1 month from removal. RESULTS At admittance, 93.5% patients were dysphagic and 37.9% had respiratory complications (mainly accumulation of supraglottic secretions). At first discharge, dysphagia was reduced (62.1%) and respiratory complications increased (41.1%). Tracheostomy was removed during the first stay in 55.3% patients, during follow-up in 13%, without failures among the 80 patients who followed the protocol. Four decannulations performed against protocol recommendations resulted in three failures. Decannulation was mainly prevented by the persistence of respiratory complications and dysphagia that constituted a relevant risk of aspiration and suffocation; decannulation was mainly postponed because of respiratory complications and breath-holding spells in very young children. CONCLUSIONS By applying a decannulation protocol that privileges safety over quickness, we encountered no failure. Respiratory complications and dysphagia that lead to supraglottic stagnation, and breath-holding spells, are key elements to consider before performing decannulation in pediatric patients.
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Affiliation(s)
- Marco Pozzi
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Sara Galbiati
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | | | - Emilio Clementi
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy.,Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, CNR Institute of Neuroscience, "Luigi Sacco" University Hospital, Università di Milano, Milan, Italy
| | - Sandra Strazzer
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
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Bonvento B, Wallace S, Lynch J, Coe B, McGrath BA. Role of the multidisciplinary team in the care of the tracheostomy patient. J Multidiscip Healthc 2017; 10:391-398. [PMID: 29066907 PMCID: PMC5644554 DOI: 10.2147/jmdh.s118419] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Tracheostomies are used to provide artificial airways for increasingly complex patients for a variety of indications. Patients and their families are dependent on knowledgeable multidisciplinary staff, including medical, nursing, respiratory physiotherapy and speech and language therapy staff, dieticians and psychologists, from a wide range of specialty backgrounds. There is increasing evidence that coordinated tracheostomy multidisciplinary teams can influence the safety and quality of care for patients and their families. This article reviews the roles of these team members and highlights the potential for improvements in care.
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Affiliation(s)
- Barbara Bonvento
- Acute Intensive Care Unit, University Hospital South Manchester, Manchester
| | - Sarah Wallace
- Acute Intensive Care Unit, University Hospital South Manchester, Manchester.,Royal College of Speech and Language Therapists, London, UK
| | - James Lynch
- Acute Intensive Care Unit, University Hospital South Manchester, Manchester
| | - Barry Coe
- Acute Intensive Care Unit, University Hospital South Manchester, Manchester
| | - Brendan A McGrath
- Acute Intensive Care Unit, University Hospital South Manchester, Manchester
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McDonald J, McKinlay E, Keeling S, Levack W. The ‘wayfinding’ experience of family carers who learn to manage technical health procedures at home: a grounded theory study. Scand J Caring Sci 2017; 31:850-858. [DOI: 10.1111/scs.12406] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 10/06/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Janet McDonald
- Department of Primary Health Care and General Practice; University of Otago; Wellington New Zealand
| | - Eileen McKinlay
- Department of Primary Health Care and General Practice; University of Otago; Wellington New Zealand
| | - Sally Keeling
- Department of Medicine; University of Otago; Christchurch New Zealand
| | - William Levack
- Rehabilitation Teaching and Research Unit; Department of Medicine; University of Otago; Wellington New Zealand
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Tolomeo CT, Major NE, Szondy MV, Bazzy-Asaad A. Standardizing Care and Parental Training to Improve Training Duration, Referral Frequency, and Length of Stay: Our Quality Improvement Project Experience. J Pediatr Nurs 2017; 32:72-79. [PMID: 28341025 DOI: 10.1016/j.pedn.2016.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 10/12/2016] [Accepted: 10/21/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES At our institution, there is a six bed Pediatric Respiratory Care Unit for technology dependent infants and children with a tracheostomy tube. A lack of consistency in patient care and parent/guardian education prompted our group to critically evaluate the services we provided by revisiting our teaching protocol and instituting a new model of care in the Unit. The aims of this quality improvement (QI) project were to standardize care and skills proficiency training to parents of infants with a tracheostomy tube in preparation for discharge to home. METHODS After conducting a current state survey of key unit stakeholders, we initiated a multidisciplinary, QI project to answer the question: 'could a standardized approach to care and training lead to a decrease in parental/guardian training time, a decrease in length of stay, and/or an increase in developmental interventions for infants with tracheostomy tubes'? A convenience sample of infants with a tracheostomy tube admitted to the Pediatric Respiratory Care Unit were included in the study. Descriptive statistics were used to analyze the results. RESULTS Through this QI approach, we were able to decrease the time required by parents to achieve proficiency in the care of a technology dependent infant, the length of stay for these infants, and increase referral of the infants for developmental assessment. CONCLUSIONS These outcomes have implications for how to approach deficiencies in patient care and make changes that lead to sustained improvements.
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Affiliation(s)
- Concettina Tina Tolomeo
- Yale University School of Medicine, Department of Pediatrics, Section of Respiratory Medicine, 333 Cedar Street, LMP 3094, New Haven, CT 06520-8064, United States.
| | - Nili E Major
- Yale University School of Medicine, Department of Pediatrics, Developmental & Behavioral Pediatrics, 1 Long Wharf Drive, 5(th) Floor, New Haven, CT 06511, United States
| | - Mary V Szondy
- Yale New Haven Children's Hospital, Department of Care Coordination, 1 Park Street, New Haven, CT 06510, United States
| | - Alia Bazzy-Asaad
- Yale University School of Medicine, Department of Pediatrics, Section of Respiratory Medicine, 333 Cedar Street, LMP 3094, New Haven, CT 06520-8064, United States
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Neonates and Infants Discharged Home Dependent on Medical Technology: Characteristics and Outcomes. Adv Neonatal Care 2016; 16:379-389. [PMID: 27275531 DOI: 10.1097/anc.0000000000000314] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Preterm neonates and neonates with complex conditions admitted to a neonatal intensive care unit (NICU) may require medical technology (eg, supplemental oxygen, feeding tubes) for their continued survival at hospital discharge. Medical technology introduces another layer of complexity for parents, including specialized education about neonatal assessment and operation of technology. The transition home presents a challenge for parents and has been linked with greater healthcare utilization. PURPOSE To determine incidence, characteristics, and healthcare utilization outcomes (emergency room visits, rehospitalizations) of technology-dependent neonates and infants following initial discharge from the hospital. METHODS This descriptive, correlational study used retrospective medical record review to examine technology-dependent neonates (N = 71) upon discharge home. Study variables included demographic characteristics, hospital length of stay, and type of medical technology used. Analysis of neonates (n = 22) with 1-year postdischarge data was conducted to identify relationships with healthcare utilization. Descriptive and regression analyses were performed. FINDINGS Approximately 40% of the technology-dependent neonates were between 23 and 26 weeks' gestation, with birth weight of less than 1000 g. Technologies used most frequently were supplemental oxygen (66%) and feeding tubes (46.5%). The mean total hospital length of stay for technology-dependent versus nontechnology-dependent neonates was 108.6 and 25.7 days, respectively. Technology-dependent neonates who were female, with a gastrostomy tube, or with longer initial hospital length of stay were at greater risk for rehospitalization. IMPLICATIONS FOR PRACTICE Assessment and support of families, particularly mothers of technology-dependent neonates following initial hospital discharge, are vital. IMPLICATIONS FOR RESEARCH Longitudinal studies to determine factors affecting long-term outcomes of technology-dependent infants are needed.
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Groenendijk I, Booth J, van Dijk M, Argent A, Zampoli M. Paediatric tracheostomy and ventilation home care with challenging socio-economic circumstances in South Africa. Int J Pediatr Otorhinolaryngol 2016; 84:161-5. [PMID: 27063774 DOI: 10.1016/j.ijporl.2016.03.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 03/13/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Children discharged home with a tracheostomy need a safe home environment and access to health care. We described the indications, clinical characteristics, socio-economic circumstances and outcomes of children enroled in a tracheostomy home care programme in South Africa. METHODS We performed a retrospective chart review of children receiving a tracheostomy and enroled in the Breatheasy programme at the Red Cross War Memorial Children's Hospital, Cape Town. Medical and background characteristics were recorded. Influences of socio-economic variables and underlying medical conditions on length of hospital stay, unplanned readmissions and mortality in the first year after discharge were evaluated. RESULTS In the period 2008-2012, 157 patients were discharged home with a tracheostomy. Median hospital stay after tracheostomy insertion was significantly longer when parents had incomplete schooling compared to completed secondary school or higher education; 30 days (IQR 21-53) versus 23 days (IQR 16-33), respectively. Unplanned readmissions in the first year were documented for 72 patients (45.9%). The risk for unplanned readmission was 2.6 times higher in families with substance abuse the risk of respiratory infections was two-fold in case of household cigarette smoke exposure (OR 2.3.) Tracheostomy-related mortality was low (1.2%). An underlying medical condition was the only independent significant risk factor for mortality (OR 5.1, 95% CI 1.8-14.3). CONCLUSION This study demonstrates that despite difficult socio-economic circumstances, home ventilation of children with a tracheostomy is safe, provided caregivers are adequately trained and supported.
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Affiliation(s)
- Ilse Groenendijk
- Intensive Care Unit and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
| | - Jane Booth
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Monique van Dijk
- Intensive Care Unit and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Andrew Argent
- Division of Paediatric Critical Care and Children's Heart Disease, School of Child and Adolescent Health University of Cape Town; and Paediatric Intensive Care Unit Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Marco Zampoli
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
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McDonald J, McKinlay E, Keeling S, Levack W. Becoming an expert carer: the process of family carers learning to manage technical health procedures at home. J Adv Nurs 2016; 72:2173-84. [DOI: 10.1111/jan.12984] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2016] [Indexed: 12/30/2022]
Affiliation(s)
- Janet McDonald
- University of Otago; Wellington New Zealand
- Victoria University of Wellington; Wellington New Zealand
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29
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McGrath-Morrow SA, Collaco JM. Long-Term Ventilator Support in Bronchopulmonary Dysplasia. Respir Med 2016. [DOI: 10.1007/978-1-4939-3749-3_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Murray CH, Joseph RA. Transition from NICU to Home: Are the Parents Ready to Manage Any Emergency? An Evidence-Based Project. Neonatal Netw 2016; 35:151-155. [PMID: 27194609 DOI: 10.1891/0730-0832.35.3.151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Transitioning the care of a previously critically ill infant to home poses many challenges for the parents. Prior to the infant's discharge, the parents undergo rigorous training to continue the care of their infants at home. Even after training, parents may feel overwhelmed by the thought of managing an emergency at home. This evidence-based practice project aims to provide parents with additional hands-on practice of cardiopulmonary resuscitation (CPR) prior to their infant's discharge. Based on this project, a program of teaching CPR regularly is established currently in the NICU at Nemours Alfred I. duPont Hospital for Children.
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McCormick ME, Ward E, Roberson DW, Shah RK, Stachler RJ, Brenner MJ. Life after Tracheostomy: Patient and Family Perspectives on Teaching, Transitions, and Multidisciplinary Teams. Otolaryngol Head Neck Surg 2015; 153:914-20. [PMID: 26286873 DOI: 10.1177/0194599815599525] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 07/17/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To report patient/family experiences and outcomes after tracheostomy STUDY DESIGN International survey of patients and families with tracheostomy. SETTING Collaboration of the Patient Safety and Quality Improvement Committee of the American Academy of Otolaryngology-Head and Neck Surgery and the Global Tracheostomy Collaborative. METHODS A 50-item survey was developed with multistakeholder collaboration. The survey was disseminated via international social networks used by patients with a tracheostomy and their families. Qualitative and quantitative data were analyzed. RESULTS Of 220 respondents, 90% cared for a pediatric patient with a tracheostomy. Only 48% of respondents felt "very prepared" at time of discharge, and 11% did not receive emergency preparedness training prior to discharge. Home nursing needs were inadequately met in 17% of families, with resulting difficulties shortly after discharge; 14% sought emergent care within 1 week of discharge. Nearly half of respondents indicated a desire to have met with a patient with a tracheostomy prior to surgery but were not offered that opportunity. Fragmented care or limited teamwork was reported by 32% of respondents, whereas tracheotomy care was described as "integrated" or "maximally integrated" for 67%. CONCLUSION While many families report satisfaction with tracheostomy care, opportunities remain for improving care. This study highlights the importance of teaching, teamwork, and smoothing transition from the hospital. Potential quality improvement areas include standardizing tracheostomy teaching for routine and emergency needs and optimizing postdischarge support and coordination. Prior to surgery, connecting families to people with a tracheostomy may also be beneficial.
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Affiliation(s)
- Michael E McCormick
- Department of Otolaryngology and Communication Sciences, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin Patient Safety and Quality Improvement Committee, American Academy of Otolaryngology-Head and Neck Surgery, Washington, DC Global Tracheostomy Collaborative, Washington, DC
| | - Erin Ward
- Global Tracheostomy Collaborative, Washington, DC
| | - David W Roberson
- Patient Safety and Quality Improvement Committee, American Academy of Otolaryngology-Head and Neck Surgery, Washington, DC Global Tracheostomy Collaborative, Washington, DC Department of Otology and Laryngology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rahul K Shah
- Patient Safety and Quality Improvement Committee, American Academy of Otolaryngology-Head and Neck Surgery, Washington, DC Global Tracheostomy Collaborative, Washington, DC Division of Pediatric Otolaryngology, Children's National Medical Center, George Washington University, Washington, DC
| | - Robert J Stachler
- Patient Safety and Quality Improvement Committee, American Academy of Otolaryngology-Head and Neck Surgery, Washington, DC Department of Otolaryngology-Head and Neck Surgery, Henry Ford Medical Group, Detroit, Michigan, USA
| | - Michael J Brenner
- Patient Safety and Quality Improvement Committee, American Academy of Otolaryngology-Head and Neck Surgery, Washington, DC Global Tracheostomy Collaborative, Washington, DC Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
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Cottrill E, Lioy J, Elshenawy S, Rosenzweig J, Hopkins E, Chuo J, Sobol S, DeMauro S. A five year retrospective study of short term respiratory support outcomes for infants who received tracheostomy before one year of age. Int J Pediatr Otorhinolaryngol 2015; 79:15-7. [PMID: 25481332 DOI: 10.1016/j.ijporl.2014.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 09/28/2014] [Accepted: 10/04/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study aims to describe respiratory support requirements at the time of hospital discharge for infants who undergo tracheostomy, and to determine whether certain indications for tracheostomy are significantly associated with ventilator or oxygen dependence at the time of discharge. METHODS Retrospective chart review identified 150 patients who underwent tracheostomy before 1 year of age at a single center from 2007 to 2012 and were discharged alive. Patients were divided into groups based on primary indication for tracheostomy: chronic lung disease (CLD); cardiac; airway anomalies (e.g., tracheomalacia, subglottic stenosis); anatomic anomalies of head, neck and chest; neuro/muscular; mixed group (>1 primary indication). Chi-squared tests were used to compare respiratory support requirements at time of discharge, as well as need for supplemental oxygen. RESULTS Of the 150 patients included in the study, three were discharged on room air alone. Of those 147 who did require some form of support at discharge, significant differences were found between groups when comparing CPAP to ventilator support. For example, of the patients with CLD, 82% were discharged on ventilator support whereas of those with a primary airway indication nearly 54% were discharged on CPAP. Significant differences were also found among groups when comparing patients discharged on room air vs. supplemental oxygen. Patients with CLD were more likely to be discharged on supplemental oxygen (p=0.001) whereas of the patients with anatomic indication 77% required no supplemental oxygen at the time of discharge. CONCLUSION Respiratory support needs at the time of discharge for neonates who underwent tracheostomy varied significantly depending on the initial indication for tracheostomy. Information about respiratory requirements of infants who undergo tracheostomy can help clinicians counsel families and anticipate post-discharge needs.
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Affiliation(s)
- Elizabeth Cottrill
- Otorhinolaryngology, University of Pennsylvania Health System, Philadelphia, PA, United States.
| | - Janet Lioy
- Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Summer Elshenawy
- Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Jaclyn Rosenzweig
- Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Edward Hopkins
- Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - John Chuo
- Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Steven Sobol
- Otorhinolaryngology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Sara DeMauro
- Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
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Yelverton JC, Nguyen JH, Wan W, Kenerson MC, Schuman TA. Effectiveness of a standardized education process for tracheostomy care. Laryngoscope 2014; 125:342-7. [DOI: 10.1002/lary.24821] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 06/10/2014] [Accepted: 06/13/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Joshua C. Yelverton
- Department of Otolaryngology-Head and Neck Surgery; Virginia Commonwealth University; Richmond Virginia U.S.A
| | - Josephine H. Nguyen
- Department of Otolaryngology-Head and Neck Surgery; Virginia Commonwealth University; Richmond Virginia U.S.A
| | - Wen Wan
- Department of Biostatistics; Virginia Commonwealth University; Richmond Virginia U.S.A
| | - Michael C. Kenerson
- Department of Otolaryngology-Head and Neck Surgery; Virginia Commonwealth University; Richmond Virginia U.S.A
| | - Theodore A. Schuman
- Department of Otolaryngology-Head and Neck Surgery; Virginia Commonwealth University; Richmond Virginia U.S.A
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Mitchell RB, Hussey HM, Setzen G, Jacobs IN, Nussenbaum B, Dawson C, Brown CA, Brandt C, Deakins K, Hartnick C, Merati A. Clinical consensus statement: tracheostomy care. Otolaryngol Head Neck Surg 2012; 148:6-20. [PMID: 22990518 DOI: 10.1177/0194599812460376] [Citation(s) in RCA: 232] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This clinical consensus statement (CCS) aims to improve care for pediatric and adult patients with a tracheostomy tube. Approaches to tracheostomy care are currently inconsistent among clinicians and between different institutions. The goal is to reduce variations in practice when managing patients with a tracheostomy to minimize complications. METHODS A formal literature search was conducted to identify evidence gaps and refine the scope of this consensus statement. The modified Delphi method was used to refine expert opinion and facilitate a consensus position. Panel members were asked to complete 2 scale-based surveys addressing different aspects of pediatric and adult tracheostomy care. Each survey was followed by a conference call during which results were presented and statements discussed. RESULTS The panel achieved consensus on 77 statements; another 39 were dropped because of lack of consensus. Consensus was reached on statements that address initial tracheostomy tube change, management of emergencies and complications, prerequisites for decannulation, management of tube cuffs and communication devices, and specific patient and caregiver education needs. CONCLUSION The consensus panel agreed on statements that address the continuum of care, from initial tube management to complications in children and adults with a tracheostomy. The panel also highlighted areas where consensus could not be reached and where more research is needed. This consensus statement should be used by physicians, nurses, and other stakeholders caring for patients with a tracheostomy.
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Affiliation(s)
- Ron B Mitchell
- Department of Otolaryngology, UT Southwestern Medical Center, Dallas, Texas 75207, USA.
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