Pilot study of an interprofessional pediatric mechanical ventilation educational initiative in two intensive care units

Abstract

Introduction: Inappropriate ventilator settings, non-adherence to a lung-protective ventilation strategy, and inadequate patient monitoring during mechanical ventilation can potentially expose critically ill children to additional risks. We set out to improve team theoretical knowledge and practical skills regarding pediatric mechanical ventilation and to increase compliance with treatment goals.

Methods: An educational initiative was conducted from August 2019 to July 2021 in a neonatal and pediatric intensive care unit of the University Children's Hospital, Hamburg-Eppendorf, Germany. We tested baseline theoretical knowledge using a multiple choice theory test (TT) and practical skills using a practical skill test (PST), consisting of four sequential Objective Structured Clinical Examinations of physicians and nurses. We then implemented an educational bundle that included video self-training, checklists, pocket cards, and reevaluated team performance. Ventilators and monitor settings were randomly checked in all ventilated patients. We used a process control chart and a mixed-effects model to analyze the primary outcome.

Results: A total of 47 nurses and 20 physicians underwent assessment both before and after the implementation of the initiative using TT. Additionally, 34 nurses and 20 physicians were evaluated using the PST component of the initiative. The findings revealed a significant improvement in staff performance for both TT and PST (TT: 80% [confidence interval (CI): 77.2-82.9] vs. 86% [CI: 83.1-88.0]; PST: 73% [CI: 69.7-75.5] vs. 95% [CI: 93.8-97.1]). Additionally, there was a notable increase in self-confidence among participants, and compliance with mechanical ventilation treatment goals also saw a substantial rise, increasing from 87.8% to 94.5%.

Discussion: Implementing a pediatric mechanical ventilation education bundle improved theoretical knowledge and practical skills among interprofessional pediatric intensive care staff and increased treatment goal compliance in ventilated children.

Keywords: Checklists; Educational film; Educational initiative; Selfconfidence; Team performance; Treatment goal compliance.

Fig. 1

Timeline and Key Events during the Initiative to Improve Ventilation Quality in Children in Neonatal and Pediatric Intensive Care Units. This figure illustrates the chronological sequence of milestones, training, and evaluation measures during the initiative to enhance ventilator quality for children in neonatal and pediatric intensive care units. The timeline represents pre-intervention, implementation, and post-intervention time points. As part of the intervention, staff engaged in self-study by streaming the educational film 185 times (yellow triangles). Additionally, six collaborative video training sessions with discussions were conducted to enhance training (light green triangles). Team performance was assessed through theory tests (TT) and practical skill tests (PST) during 42 evaluation sessions (light green dots). Furthermore, compliance with patient-specific treatment goals was monitored through 662 random checks across 213 patients receiving respiratory support in both intensive care units (dark blue-green dots). During the SARS-CoV-2 pandemic, between February 2020 and April 2020, the random checks were temporarily paused due to visiting restrictions (light red ribbon)

Fig. 2

Theoretical knowledge, practical skills, and time for ventilator setup of nurses and physicians pre- and post-intervention

Fig. 3

Predictors of theoretical knowledge and practical skills performance

Fig. 4

Statistical process control chart illustrating adherence to treatment goals (black horizontal line) with control limits before (dark red) and after (dark green) the implementation of an intervention bundle to improve the quality of mechanical ventilation in children plotted as running means. The checks covered ventilator setup, ventilator display, volume, pressure, and pulse oximetry target monitoring