1602P - Simulation training for compassionate extubation in the pediatric intensive care unit

Background

When a child has a life-limiting, irreversible condition such as advanced cancer, a healthcare team and family may decide to limit care lacking clear benefit. In such circumstances, a compassionate extubation, or discontinuation of life-sustaining ventilator support allowing natural death, may be pursued. Compassionate extubations are an infrequently performed procedure with complexities that include difficult conversations and dynamic symptom management which can lend to this being a challenging process to execute, particularly without opportunity for practice. Simulation can be a helpful tool to enhance knowledge, confidence, and preparedness with unfamiliar or uncommon scenarios in a safe environment. A compassionate extubation simulation training experience focusing on the conversational and technical skills was implemented within the Pediatric Intensive Care Unit at an academic medical center in New York City. The aim of the project was to determine whether participation in one simulation training improved healthcare providers’ confidence with performing a compassionate extubation.

Methods

A one group pretest-posttest design project was implemented using The Confidence Scale to evaluate RN and APRN confidence with performing a compassionate extubation before and after the simulation. The sample was described using descriptive statistical analysis and the Wilcoxon signed-rank test was used to evaluate for differences between first and second observations.

Results

A Wilcoxon signed-rank test determined that the compassionate extubation simulation elicited a statistically significant median increase in C-Scale scores after participation in the simulation (median = 20) compared to C-Scale scores prior (median = 12), W = 45, p = 0.007.

Conclusions

Affording opportunity for healthcare providers to sculpt and refine their practice with certain challenging clinical scenarios has been shown to improve their confidence navigating these situations. All efforts to improve confidence related to sensitive situations such as with a compassionate extubation are made with the intention of improving the experience of children at the end of their lives as well as the experiences of the families and loved ones who walk this journey with them.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The author.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.