Pediatric Ventilation Liberation: Bundled Extubation Readiness and Analgosedation Pathways Decrease Mechanical Ventilation Duration and Benzodiazepine Exposure.

BACKGROUND: Recent studies reported that children on mechanical ventilation who were managed with an analgosedation approach and standardized extubation readiness testing experienced better outcomes, including decreased delirium and invasive mechanical ventilation duration. METHODS: This was a quality improvement project in a 24-bed pediatric ICU within a single center, including subjects ≤ 18 years old who required invasive mechanical ventilation via an oral or nasal endotracheal tube. The aim was to decrease the invasive mechanical ventilation duration for all the subjects by 25% within 9 months through the development and implementation of bundled benzodiazepine-sparing analgosedation and extubation readiness testing clinical pathways. RESULTS: In the pre-implementation cohort, there were 274 encounters, with 253 (92.3%) that met inclusion for ending in an extubation attempt. In the implementation cohort, there were 367 encounters with 332 (90.5%) that ended in an extubation attempt. The mean invasive mechanical ventilation duration decreased by 23% (Pre 3.95 d vs Post 3.1 d; P = .039) after the implementation without a change in the mean pediatric ICU length of stay (Pre 7.5 d vs Post 6.5 d; P = .42). No difference in unplanned extubation (P > .99) or extubation failure rates (P = .67) were demonstrated. Sedation levels as evaluated by the mean State Behavioral Scale were similar (Pre -1.0 vs Post -1.1; P = .09). The median total benzodiazepine dose administered decreased by 75% (Pre 0.4 vs Post 0.1 mg/kg/ventilated day; P < .001). No difference in narcotic withdrawal (Pre 17.8% vs Post 16.4%; P = .65) or with delirium treatment (Pre 5.5% vs Post 8.7%; P = .14) was demonstrated. CONCLUSIONS: A multidisciplinary, bundled benzodiazepine-sparing analgosedation and extubation readiness testing approach resulted in a reduction in mechanical ventilation duration and benzodiazepine exposure without impacting key balancing measures. External validity needs to be evaluated in similar centers and consensus on best practices developed.

Training Where and When It Is Needed: In Situ Simulation Using a Traveling Education Cart.

BACKGROUND: In recent years, simulation educators have focused on in situ simulations wherein they bring education to providers' workplaces in efforts to reduce clinical disruptions and eliminate travel costs. However, these efforts have remained unfulfilling as education rooms must be secured and other providers must replace those attending the on-site education. METHOD: The authors propose a super mobile educational modality wherein simulation education is brought to workplaces on a cart. This traveling education cart trains individuals or small groups on one topic or skill at a time, offering learners quick, on-the-job training and refreshers without the need for educational rooms or fill-ins. Education happens whenever there is a need and wherever the cart will fit. RESULTS: Results reveal that the succinct education offered by this cart is effective and well-received. CONCLUSION: This study presents a novel training modality in an efficient, noninvasive, yet effective means for health care providers that may be replicated in other hospitals. [J Contin Educ Nurs. 2020;51(10):465-468.].

The impact of workplace policies and other social factors on self-reported influenza-like illness incidence during the 2009 H1N1 pandemic.

OBJECTIVES: We assessed the impact of social determinants of potential exposure to H1N1--which are unequally distributed by race/ethnicity in the United States--on incidence of influenza-like illness (ILI) during the 2009 H1N1 pandemic. METHODS: In January 2010 we surveyed a nationally representative sample (n = 2079) of US adults from the Knowledge Networks online research panel, with Hispanic and African American oversamples. The completion rate was 56%. RESULTS: Path analysis examining ILI incidence, race, and social determinants of potential exposure to H1N1 demonstrated that higher ILI incidence was related to workplace policies, such as lack of access to sick leave, and structural factors, such as number of children in the household. Hispanic ethnicity was related to a greater risk of ILI attributable to these social determinants, even after we controlled for income and education. CONCLUSIONS: The absence of certain workplace policies, such as paid sick leave, confers a population-attributable risk of 5 million additional cases of ILI in the general population and 1.2 million cases among Hispanics. Federal mandates for sick leave could have significant health impacts by reducing morbidity from ILI, especially in Hispanics.

The effects of virtual intravenous and patient simulator training compared to the traditional approach of teaching nurses: a research project on peripheral i.v. catheter insertion.

Teaching intravenous (i.v.) catheter insertion where nurses "see one, do one, and teach one" is standard protocol, yet it allows little opportunity for practice. This study assesses the effectiveness of using mannequins and simulators to train nurses. Participants were randomly assigned to an experimental or a control group for training, and afterward they completed an i.v. insertion survey for each peripheral i.v. they performed. There was a significant relationship between the number of i.v. insertion attempts and the type of training, Χ (1, N = 41) = 4.19, P = .041, ϕ = 0.32, and a significant difference in the number of i.v. insertion attempts between the 2 groups, U = 143, P = .043.