Simulation-Facilitated Education for Pediatric Critical Care Nurse Practitioners' Airway Management Skills: A 10-Year Experience

Abstract

This study aimed to describe the process of the development and implementation with report of our 10-year experience with a simulation-facilitated airway management curriculum for pediatric acute care nurse practitioners in a large academic pediatric intensive care unit. This is a retrospective observational study. The study was conducted at a single-center quaternary noncardiac pediatric intensive care unit in an urban children's hospital in the United States. A pediatric critical care airway management curriculum for nurse practitioners consisting 4 hours of combined didactic and simulation-facilitated education followed by hands-on experience in the operating room. Tracheal intubations performed by nurse practitioners in the pediatric intensive care unit were tracked by a local quality improvement database, NEAR4KIDS from January 2009 to December 2018. Since curriculum initiation, 39 nurse practitioners completed the program. Nurse practitioners functioned as the first provider to attempt intubation in 473 of 3,128 intubations (15%). Also, 309 of 473 (65%) were successful at first attempt. Implementation of a simulation-facilitated pediatric airway management curriculum successfully supported the ongoing airway management participation and first attempt intubation success by nurse practitioners in the pediatric intensive care unit over the 10-year period.

Keywords

intubation - airway management - simulation education - pediatric critical care - nurse practitioner

• References

• 1 Gigli KH, Dietrich MS, Buerhaus PI, Minnick AF. Regulation of pediatric intensive care unit nurse practitioner practice: a national survey. J Am Assoc Nurse Pract 2018; 30 (01) 17-26
• 2 Hravnak M, Tuite P, Baldisseri M. Expanding acute care nurse practitioner and clinical nurse specialist education: invasive procedure training and human simulation in critical care. AACN Clin Issues 2005; 16 (01) 89-104
• 3 Nishisaki A, Turner DA, Brown III CA, Walls RM, Nadkarni VM. National Emergency Airway Registry for Children (NEAR4KIDS), Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. A National Emergency Airway Registry for children: landscape of tracheal intubation in 15 PICUs. Crit Care Med 2013; 41 (03) 874-885
• 4 Sanders Jr. RC, Giuliano Jr. JS, Sullivan JE. et al; National Emergency Airway Registry for Children Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network. Level of trainee and tracheal intubation outcomes. Pediatrics 2013; 131 (03) e821-e828
• 5 Branca A, Tellez D, Berkenbosch J. et al; National Emergency Airway Registry for Children (NEAR4KIDS) Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI). The new trainee effect in tracheal intubation procedural safety across PICUs in North America: a report from National Emergency Airway Registry for Children. Pediatr Crit Care Med 2020; 21 (12) 1042-1050
• 6 Nishisaki A, Nguyen J, Colborn S. et al. Evaluation of multidisciplinary simulation training on clinical performance and team behavior during tracheal intubation procedures in a pediatric intensive care unit. Pediatr Crit Care Med 2011; 12 (04) 406-414
• 7 Nishisaki A, Donoghue AJ, Colborn S. et al. Effect of just-in-time simulation training on tracheal intubation procedure safety in the pediatric intensive care unit. Anesthesiology 2010; 113 (01) 214-223
• 8 Kaplow R. AACN Synergy Model for Patient Care: a framework to optimize outcomes. Crit Care Nurse 2003; (Suppl): 27-30
• 9 Branch RM, Merrill MD. Characteristics of instructional design models. In: Reiser RA, Dempsey JV. eds. Trends and Issues in Instructional Design and Technology. 3rd ed.. Columbus, OH: Pearson Education; 2012: 8-16
• 10 Fernandes RAML, de Oliveira Lima JT, da Silva BH, Sales MJT, de Orange FA. Development, implementation and evaluation of a management specialization course in oncology using blended learning. BMC Med Educ 2020; 20 (01) 37
• 11 Pirie J, Kappus L, Sudikoff S, Bhanji F. Simulation curriculum development, competency-based education, and continuing professional development. In: Grant V, Cheng A. eds. Comprehensive Healthcare Simulation: Pediatrics. 1st ed.. Switzerland: Springer International Publishing; 2016: 181-193
• 12 Prakash S, Bihari S, Laver R. et al. Prospective randomized controlled trial of video- versus recall-assisted reflection in simulation-based teaching on acquisition and retention of airway skills among trainees intubating critically ill patients. Crit Care Med 2020; 48 (09) 1265-1270
• 13 Nishisaki A, Donoghue AJ, Colborn S. et al. Development of an instrument for a primary airway provider's performance with an ICU multidisciplinary team in pediatric respiratory failure using simulation. Respir Care 2012; 57 (07) 1121-1128
• 14 Nishisaki A, Hales R, Biagas K. et al. A multi-institutional high-fidelity simulation “boot camp” orientation and training program for first year pediatric critical care fellows. Pediatr Crit Care Med 2009; 10 (02) 157-162
• 15 Parker MM, Nuthall G, Brown III C. et al; Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. Relationship between adverse tracheal intubation associated events and PICU outcomes. Pediatr Crit Care Med 2017; 18 (04) 310-318
• 16 Rehder KJ, Giuliano Jr. JS, Napolitano N. et al; National Emergency Airway Registry for Children and Pediatric Acute Lung Injury and Sepsis Investigators. Increased occurrence of tracheal intubation-associated events during nights and weekends in the PICU. Crit Care Med 2015; 43 (12) 2668-2674
• 17 Provost LP, Murray SK. Learning from variation in data. In: The Health Care Data Guide. 1st ed.. Jossey-Bass Publishing; 2011: 107-147
• 18 Ishizuka M, Rangarajan V, Sawyer TL. et al; National Emergency Airway Registry for Children Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network. The development of tracheal intubation proficiency outside the operating suite during pediatric critical care medicine fellowship training: a retrospective cohort study using cumulative sum analysis. Pediatr Crit Care Med 2016; 17 (07) e309-e316
• 19 Neubrand TL, Alletag M, Woods J, Mendenhall M, Leonard J, Schmidt SK. Breathing easier: decreasing tracheal intubation-associated adverse events in the pediatric ED and urgent care. Pediatr Qual Saf 2019; 4 (06) e230
• 20 Donoghue AJ, Ades AM, Nishisaki A, Deutsch ES. Videolaryngoscopy versus direct laryngoscopy in simulated pediatric intubation. Ann Emerg Med 2013; 61 (03) 271-277
• 21 Grunwell JR, Kamat PP, Miksa M. et al; National Emergency Airway Registry for Children (NEAR4KIDS) and the Pediatric Acute Lung Injury and Sepsis (PALISI) Network. Trend and outcomes of video laryngoscope use across PICUs. Pediatr Crit Care Med 2017; 18 (08) 741-749
• 22 Gabrani A, Kojima T, Sanders Jr. RC. et al; National Emergency Airway Registry for Children (NEAR4KIDS) Collaborators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI). Downward trend in pediatric resident laryngoscopy participation in PICUs. Pediatr Crit Care Med 2018; 19 (05) e242-e250
• 23 Thammasitboon S, Brand PLP. The physiology of learning: strategies clinical teachers can adopt to facilitate learning. Eur J Pediatr 2022; 181 (02) 429-433
• 24 Sorce L, Simone S, Madden M. Educational preparation and postgraduate training curriculum for pediatric critical care nurse practitioners. Pediatr Crit Care Med 2010; 11 (02) 205-212
• 25 Brown KM, Hunt EA, Duval-Arnould J. et al. Pediatric critical care simulation curriculum: training nurse practitioners to lead in the management of critically ill children. J Pediatr Health Care 2020; 34 (06) 584-590
• 26 Brown KM, Mudd SS, Hunt EA. et al. A multi-institutional simulation boot camp for pediatric cardiac critical care nurse practitioners. Pediatr Crit Care Med 2018; 19 (06) 564-571
• 27 Daly Guris RJ, Doshi A, Boyer DL. et al. Just-in-time simulation to guide workflow design for coronavirus disease 2019 difficult airway management. Pediatr Crit Care Med 2020; 21 (08) e485-e490
• 28 Kabi A, Dhar M, Arora P, Bhardwaj BB, Chowdhury N, Rao S. Effectiveness of a simulation-based training program in improving the preparedness of health care workers involved in airway management of COVID-19 patients. Cureus 2021; 13 (08) e17323
• 29 Temsah MH, Alrabiaah A, Al-Eyadhy A. et al. COVID-19 critical care simulations: an international cross-sectional survey. Front Public Health 2021; 9: 700769
• 30 Balikai SC, Badheka A, Casey A. et al. Simulation to train pediatric ICU teams in endotracheal intubation of patients with COVID-19. Pediatr Qual Saf 2020; 6 (01) e373
• 31 Miller AG, Napolitano N, Turner DA, Rehder KJ, Nishisaki A. National Emergency Airway Registry for Children (NEAR4KIDS) Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI). Respiratory therapist intubation practice in pediatric ICUs: a multicenter registry study. Respir Care 2020; 65 (10) 1534-1540