Fulfilling an Urgent Need for Pronation Education Using Simulation (1090-000131) (To be presented in the session entitled, Research Abstract Oral: COVID-19)
Start time: Friday, January 22, 2021, 9:30 AM End time: Friday, January 22, 2021, 10:30 AM Session Type: Research Abstracts (Completed Studies)
The 2019 Novel Coronavirus, otherwise known as COVID-19, made it’s way to the United States in early 2020. The evolving situation quickly escalated into an international pandemic. Critically ill patients with COVID-19 have a high likelyhood of developing Acute Respiratory Distress Syndrome (ARDS) and requiring adjunctive therapies such as prone position ventilation (PPV). PPV education was implemented at a large teaching hospital in the mid-west. Prior to the COVID-19 pandemic, only certain units were educated on PPV. This created a gap in knowledge. Simulation was utilized as an education modality to address this gap. Interpforessional simulation-based training can improve provider comfort with PPV (1). In an effort to prepare caregivers to care for COVID-19 patients, additional PPV education was quickly assembled. The hypothesis formed was: Can simulation be used to prepare caregivers to safely and effictively implement PPV for patients in ARDS due to COVID-19?
Pronation education was provided using multimodal instructional strategies. Participants attended a three hour class on pronation therapy. The first hour consisted of didiactic based education incorporating video based learning, low-fidelity simulation, discussion, and question and answer. The second two hours, caregivers participated in two different simulations, each followed by a debrief. One simulatoin involved a high fidelity manikin that was moulaged with an endotracheal tube, ventilator, arterial line, peripheral IV, triple lumen internal jugular central line with multiple continuous infusions, a urinary catheter, ECG leads, and a pulse oximeter. The second simulation involved a standardized patient. Class size was limited to twenty participants in order to maintain adequate social distancing guidelines and group sizes of ten or less. Participants consisted of Registered Nurses, Licensed Independent Practictioners, Physicians, and Respiratory Therapists.
Learners completed a standard evaluation immediately after the debrief. 118 out of 173 learners completed the evaluation. On the evaluation, all 118 learners reported the simulation experience evoked critical thinking skills and was appropriate to their clinical role. Using a scale of 0 to 9, with 0 representing “poor” and 9 representing “exceptional,” the average score for the overall experience using simulation was 7.84, the overall learning during the session was 7.88, the relevance of learning outcomes to practice was 8.01 and the overall instructor rating was 7.96. Two open ended questions were included in the evaluation: “My simulation experience was positive because,” and “My simulation experience would have been better if.” Responses were classified into 5 main themes. Most free text responses commented on the benefits of hands on education and practice. Additional themes included facilitator style, followed by content, length of the course, and team dynamics.
Findings supported the original hypothesis and objectives for the project. Simulation proved to be an effective modality for pronation training. Objectives for the high-fidelity simulation were to prepare the manikin for pronation therapy (utilizing foam prevention dressings, eye patches, and additional IV securement), assign team roles, and implement manual pronation therapy. The standardized patient (SP) simulation consisted of proning a human in a hospital bed. There was no moulage involved. While participants were unable to implement appropriate preparation measures, after proning the SP, they received feedback on positioning and comfort. Twelve pronation classes were offered from February through April of 2020. 173 caregivers attend the pronation course, and an additional 299 caregivers were educated with supplemental in-situ pronation simulation. 472 caregivers total participated in pronation simulation between the two modalities.