2005 OPEN FORUM Abstracts
HOME DISCHARGE OF TECHNOLOGY DEPENDENT CHILDREN: EVALUATION OF A RESPIRATORY CARE PRACTITONER DRIVEN FAMILY EDUCATION PROGRAM
Donna K. Tearl CRT, James H. Hertzog, MD. Departments of Respiratory Care Services and Anesthesiology and Critical Care Medicine, Alfred I. duPont Hospital for Children, Wilmington, DE.
Background: Initial hospital discharge to home of technology dependent children requires extensive training and education of the family caregivers. Education of adult family members should promote positive interactions in a non-threatening manner while facilitating the development of the knowledge and skills to competently and independently provide all aspects of the medical care. We created a training program utilizing multiple teaching tools and activities to develop appropriate clinical skills to manage children with tracheostomies and the associated technological supports.
Method: A comprehensive teaching program directed by a dedicated respiratory care practitioner (RCP) family educator was offered to the caregivers of all children who had undergone tracheostomy placement for long term mechanical ventilatory support. Educational materials consisted of written training manuals, illustrations, visual aids and interactive sessions with the caregivers and child. Training was initiated as soon as 24 hours after the tracheostomy surgery was performed. Education continued through the next 6-8 weeks and was individualized based on the caregiver's educational needs and limitations. Repetition and positive reinforcement through practice and interactions occurred regularly. Assessment of the caregiver's skill development, competence and independence were monitored. At the conclusion of training, a 24-hour supervised family care session (SFC) was performed. During the SFC, caregivers performed all aspects of their child's medical care and demonstrated their comfort levels, competence, and critical skills sets. Evaluation of the effectiveness of this program included the administration of a written test to caregivers at the start and the conclusion of training. Statistical differences in test results were analyzed using Wilcoxon Signed Ranks Test. In addition, the same posttest was administered to RCP for comparison. Caregivers were surveyed on their opinions regarding the performance of the RCP family educator using a 5-point Likert score. Surveys were also conducted 1 month after discharge with the durable medical equipment company (DME) to evaluate the DME's impression of caregiver competency in the home with respiratory equipment and procedures.
Results: Testing was performed on 20 caregivers for ventilator dependent children. There were statistically significant improvements (p=0.001) in test scores. This compares to a mean score of 86.7% for 10 RCP.
The RCP family educator was rated as "5" (most positive) by 86% of caregivers and "4" by 13% of caregivers on eight education questions, and rated overall satisfaction at 4.92. DME personnel were 100% satisfied with caregiver competency in the home one month after discharge.
Conclusion: Our training program involving a designated RCP family educator to prepare the caretakers of technology dependent children for initial hospital discharge to home appears to be effective and satisfying to family caretakers.