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Nutr Clin Pract. 2019 Oct 7. doi: 10.1002/ncp.10421. [Epub ahead of print]

Learning Gaps and Family Experience, Nurse-Facilitated Home Parenteral Nutrition Simulation-Based Discharge Training: Proof-of-Concept Study.

Author information

1
Division of Gastroenterology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA.
2
Harvard Medical School, Boston, Massachusetts, USA.
3
Boston Children's Hospital Simulator Program, Boston Children's Hospital, Boston, Massachusetts, USA.
4
Child Life Services, Boston Children's Hospital, Boston, Massachusetts, USA.
5
Department of Anesthesiology, Critical Care and Pain Medicine, Boston, Massachusetts, USA.

Abstract

BACKGROUND:

Home parenteral nutrition (HPN) is a life-sustaining therapy for children and adults suffering with severe digestive diseases, yet complications are commonplace, and predischarge trainings are variable. High-fidelity simulation training provides participants with an immersive experience using realistic equipment, supplies, and scenarios. Simulation training is rapidly becoming a potential gold standard for healthcare but is currently underutilized for families and caregivers.

METHODS:

We prospectively collected data on pediatric patients managed at a single HPN program from September 1, 2016, to September 30, 2018. Participants in a pilot simulation-based training program (orientation, high-fidelity mannequin, realistic homelike space, standardized clinical scenarios, and structured debriefing) were compared with historical controls. We excluded patients with short-term HPN use and strictly palliative goals of care.

RESULTS:

Nineteen (90%) families participated in the pilot initiative with a median (interquartile range) age of 0.9 (3.7) years and diagnosis of short-bowel syndrome in 14 (74%). During teaching scenarios, learning gaps were identified for aseptic needleless changes (53%), HPN equipment setup (84%) with specific difficulty adding multivitamin (32%), and dressing changes (63%). Thirty-day readmission rates in simulation-based training group vs historical cases were 42% vs 63% (P = not significant). There was no difference in length of stay between groups. All (100%) simulation-based training group participants would recommend this learning experience to others.

CONCLUSION:

HPN discharge training is a novel use for high-fidelity simulation to address family/caregiver satisfaction and to identify learning gaps. Further studies are needed to refine predischarge training materials and examine the impact on postdischarge outcomes.

KEYWORDS:

home parenteral nutrition; learning; patient education; short bowel syndrome; simulation training; teaching

PMID:
31589007
DOI:
10.1002/ncp.10421

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