Emergency airway and ventilator procedures for community based home care staff validation of an educational program.

Background: Children discharged home with tracheostomy and chronic mechanical ventilator support are at high risk for complications and adverse events. Private duty nursing and home respiratory care services are a critical support necessary for successful discharge. The literature suggests that there are opportunities for home care staff (HCS) to improve upon the skills necessary to assess and intervene in an emergency thereby increasing the likelihood of improving long-term outcomes.

Methods: HCS (RN, LPN, RRT) participated in a 4-h session comprised of lecture and simulation. Lecture content focused on tracheostomy safety, operation of the Trilogy and LTV home ventilators, and review of their common alarms. Simulation included two scenarios simulating tracheostomy decannulation and mucous plugging events. Participant comfort with tracheostomy and ventilator management skills were measured on a five item self-assessment tool and clinical knowledge was measured using an 11 item multiple choice skills test, both of which were completed before and after the session. We tested to see if there was a change in test scores from pre- to post-intervention.

Results: Fifty-four HCS participated in the program and provided complete data sets. The vast majority (68%) were registered nurses, followed by licensed practical nurses (19%) and respiratory therapists (12%). Participant self-reported comfort with emergency skills prior to intervention was 3.2/5 which increased to 4.1/5 after intervention (P > 0.0001). Average test score prior to intervention was 62%, post intervention score increased to 82% which represented significant improvement (P > 0.0001).

Discussion: HCS are generally unprepared to intervene in an acute airway or ventilator emergency. This short, manageable program provided education that resulted in a significant improvement in both skill level and confidence.