International Journal of Healthcare Simulation

Background:

The Paediatric Long-Term Ventilation (LTV) team are increasingly discharging children home with LTV via a tracheostomy. As a result, more parents are being asked to play the role of a nurse. They receive training, prior to discharge, in highly skilled tasks to enable them to care for their child’s long-term health needs at home. Whilst Simulation-based Education (SBE) is widely used in the education of health professionals, it is not currently part of the educational programme for these parents/caregivers.

Aim:

The aim of the study was to undertake a quality improvement project to produce an SBE programme for parents/caregivers of children being discharged home on LTV via a tracheostomy. The main objective was to improve the safety of patients through improving the confidence of parents/caregivers in managing and escalating emergencies prior to their discharge.

Method/design:

Through a focus group including parents/caregivers of children receiving LTV via a tracheostomy, who are already at home, we aim to co-produce this project, with the patient voice and experiences at its core. We plan to undertake the SBE with one or more parents/caregivers in a location separate from the clinical setting, that is designed to replicate their home environment as best as possible ^[1]; present will be one facilitator from Simulation Services (SS) and one clinical expert from the LTV team. We have written a bank of scenarios, including accidental decannulation, ventilator failure and respiratory arrest requiring cardio pulmonary resuscitation and phoning of the emergency services. However, scenarios will be chosen and individualized to suit each family’s needs. We will debrief in a separate room and this will be led by the SS facilitator, with the expert from the LTV team invited in to support with their clinical knowledge.

Implementation outline:

Over the next 4 months, baseline data will be collected with a Likert scale of confidence ratings for each of the planned scenarios, prior to the SBE. We will collect these data again immediately after the SBE, and then again at 3 months. We will also ask, at both of these time points, if there is anything additional that the parents/caregivers would have wanted from the SBE and how it can be improved. These data will allow us to evaluate and develop the programme for future families through a plan-do-study-act cycle approach. To understand where SBE fits within the wider education provided to parents/caregivers, we will ask them which elements of their education they have found most useful, and why.