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

Authors
  • Raphael, Bram P1, 2
  • Takvorian-Bené, Melissa1
  • Gallotto, Mary1
  • Tascione, Christina1
  • McClelland, Jennifer1
  • Rosa, Carolyn1
  • Dinan, Jessica3
  • O'Connell, Brianna3, 4
  • Weinstock, Peter2, 3, 5
  • 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.
Type
Published Article
Journal
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
Publication Date
Apr 01, 2021
Volume
36
Issue
2
Pages
489–496
Identifiers
DOI: 10.1002/ncp.10421
PMID: 31589007
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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. 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. 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. 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. © 2019 American Society for Parenteral and Enteral Nutrition.

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