The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

HIGH FIDELITY SIMULATION TRAINING FOR THE NEW EMPLOYEE

Patricia A. Achuff1, Joseph Bolton1, Lorraine Hough1, Roberta L. Hales2; 1Respiratory Care, The Children’s Hospital of Philadelphia, Philadelphia, PA; 2Center for Simulation, Advanced Education, and Innovation, The Children’s Hospital of Philadelphia, Philadelphia, PA

Background: New employees in our respiratory care department have found BiPAP and tracheostomy tube emergencies the first stressful situations encountered in the clinical field. High fidelity simulation was used as an educational tool to increase self-confidence and improve perfomance of these skills. Method: Two scenarios, BiPAP decompensation episode and an emergency tracheostomy tube change, were trialed as part of orientation. A scale to evaluate participant perfomance, including technical and non-technical skills, was developed for both scenarios. Assessment was performed by an on-site observer with scripted facilitator debriefings. Their first session occurred in September, 2008, follow-up May, 2009. Total, technical, and non-technical scores were analyzed for both scenarios at each session. The BiPAP checklist included 21 items, 15 technical and 6 non-technical. The tracheostomy tube change checklist included 22 items, 18 technical and 4 non-technical. At each session, a Likert scale pre-survey was administered to assess confidence level for both scenarios. Level of clinical experience with BiPAP and tracheostomy tube emergencies was evaluated prior to each session. Results: Eight new employees participated in the program. Total, technical, and non-technical scores improved following initial training in both scenarios. All showed improvement in preparing the oxygen setup and adding it to the BiPAP circuit. Seven participants showed improvement in identification of patient decompensation, troubleshooting equipment, and titrating oxygen. In the second session, five participants failed to call the physician and four failed to document appropriately. After the second session, confidence improved by all with the highest change in setting up the BiPAP machine/interface and checking equipment with orders. In the tracheostomy tube scenario, all showed improvement in hyperextending the neck. Seven participants showed improvement in calling for help from others. In the second session, four participants did not attach a drainage sponge or replace supplies. After the second session, confidence improved by all with the highest change in identifying and locating emergency tracheostomy tube supplies. Conclusion: Simulation training increased confidence and perfomance scores in the absence of clinical experience in the tracheostomy tube scenario. Scores in the BiPAP scenario were higher due to simulation training and clinical experience. Sponsored Research - None

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