SC13 A report on a novel simulation intervention to up-skill adult trained physiotherapists to provide out of hours support to paediatric respiratory patients. (3rd November 2019) - Driscoll, Jacqueline
Abstract : Background: Simulation is now seen as integral to the patient safety movement. At our Trust, the simulation team sit on the patient safety committee to identify situations whereby simulation may be a suitable response to error. A recent serious incident (SI) at the hospital identified a lack of competence and confidence amongst the acute adult on call physiotherapy team in managing children and adolescents admitted with respiratory disease. There is no dedicated paediatric respiratory physiotherapist at the Trust despite children with increased complexity now being deemed suitable for admission to the short stay children's unit. Project description: After engagement with all relevant stakeholders, a one day simulation course covering the five most common and daunting respiratory conditions in children was devised including bronchiolitis, pneumonia in the well neonate, post-op atelectasis, respiratory distress in the context of cerebral palsy and pneumonia in the child with complex needs. These simulations were complemented with lectures and skills sessions on non-invasive ventilation. Faculty were drawn from the hospital and community physiotherapy team, the paediatric department and simulation faculty. A workbook and quiz were completed prior to the course. Assessment was via a knowledge and skills questionnaire that had extrapolated items from the association of charted physiotherapists in respiratory care which has been proven as a valid tool for measuring competence. There was an added self-efficacy score measuring confidence and readiness for situations that could be encountered on call. The knowledge and skill items were rated from 1–5 and with an aim that participants would achieve a score of 3 or more which equals 'practical experience and ability to work alone.' Results: 80% of participants passed the quiz pre course. Participant's scores improved in all areas as measured by the pre and post knowledge and skills questionnaire with the exception of risk assessment. Participants were above the minimum score of 3 in all areas except for risk assessment also. Self-efficacy scores measuring confidence also improved across all parameters between the pre and post course assessment. Conclusions: Changes regarding teaching on risk assessment (e.g.: risk of aspiration with some therapies) needs to be incorporated into subsequent courses. The course continues to be rolled out to all physiotherapists participating in the acute on call rota and thus far 21 physiotherapists have completed the training. Future directions include extending the training to paediatric nursing and medical staff at the trust. References: Ziv A. et al, 'Patient safety and simulation-based medical education', Medical Teacher, 22:5, pp. 489–495. Thomas S. et al, 'On-call competence: developing a tool for self-assessment', Physiotherapy, 92:3, pp. 204–211.