The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts


Patricia A. Achuff1, Kathleen Monforto2, Roberta L. Hales3

Background: Respiratory therapist confidence in skills and knowledge is essential in the care of the acute pediatric asthmatic patient. Many respiratory therapists have limited exposure to the intravenous administration of Magnesium Sulfate. High fidelity simulation was used as the educational tool to bridge this gap.

Methods: A pilot program simulating pediatric severe status asthmaticus requiring Magnesium Sulfate administration was run on a General Pediatrics Unit. A scenario, based on specific learning objectives, programmed into a Laerdal MegaCode Kid simulator was run with multidisciplinary teams. Qualified observers completed separate checklists, including technical and behavioral skills, for physicians, nurses, and respiratory therapists. Each team participated in a debriefing session post-simulation. A Likert-scale pre-survey was administered to respiratory therapists to assess Magnesium Sulfate administration confidence level. The same survey was administered two to four weeks post-simulation. Analysis included mean, standard deviation, and paired t-test.

Results: Eleven respiratory therapists participated over a 3-week period. Prior to simulation, on a Likert scale of 1-5, respiratory therapists felt extremely confident (score 5) in identifying signs of respiratory distress (mean 5.0, SD 0) and managing respiratory equipment (mean 5.0, SD 0) in severe asthma. Therapists were confident (score 4) in identifying adverse reactions of magnesium sulfate (mean 4.2, SD 0.98), describing monitoring guidelines for patients receiving magnesium sulfate (mean 4.6, SD 0.50), and identifying the respiratory therapist role in magnesium sulfate administration (mean 4.7, SD 0.47). Therapists felt somewhat confident (score 3) in recommending the use of magnesium sulfate (mean 3.6, SD 0.92), describing mechanism of action of magnesium sulfate (mean 3.6, SD 0.67), locating dosing/administration guidelines for magnesium sulfate (mean 3.5, SD 0.82), and recommending dosage guidelines of magnesium sulfate (mean 3.1, SD 0.98). Post simulation, all skills showed equal or increased confidence levels except describing monitoring guidelines for patients receiving magnesium sulfate (mean -0.1, SD 0.54). Of skills reviewed, confidence in recommending dosage guidelines of magnesium sulfate increased the most (mean 0.7, SD 0.79, p=0.01).

Conclusion: Simulation training improved respiratory therapist confidence in recommending the use and dosing guidelines of Magnesium Sulfate.