Elizabeth Sanseau1, Leah H Carr2, Jennifer Case3, Khoon-Yen Tay4, Anne Ades5, Kesi Yang6, Hannah Huang7, Anna Bustin8, Grace Good9, Shannon Gaines10, Julie Augenstein11, Daisy Ciener12, Jean Pearce13, Jennifer Reid14, Kimberly Stone14, Rebekah Burns14, Anita Thomas15. 1. Fellow, Pediatric Emergency Medicine, Children's Hospital of Philadelphia. 2. Fellow, Department of General Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia. 3. Resident, Department of General Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital. 4. Associate Professor, Clinical Pediatrics, Division of Emergency Medicine, Children's Hospital of Philadelphia. 5. Professor, Clinical Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia. 6. Assistant Professor, Clinical Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia. 7. Pharmacist, Department of General Pediatrics, Division of Emergency Medicine, Children's Hospital of Philadelphia. 8. Residency Preceptor, Pharmacy Residency Program, and Clinical Pharmacy Specialist, Neonatal/Infant Intensive Care, Children's Hospital of Philadelphia. 9. Simulation Specialist, Division of Emergency Medicine, Children's Hospital of Philadelphia. 10. Education Nurse Specialist, Division of Emergency Medicine, Children's Hospital of Philadelphia. 11. Assistant Professor, Clinical Pediatrics, Division of Emergency Medicine, Phoenix Children's Hospital. 12. Assistant Professor, Clinical Pediatrics, Division of Pediatric Emergency Medicine, Vanderbilt University Medical Center. 13. Assistant Professor, Clinical Pediatrics, Division of Emergency Medicine, Medical College of Wisconsin. 14. Associate Professor, Clinical Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital. 15. Assistant Professor, Clinical Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital.
Abstract
Introduction: The American Academy of Pediatrics recommends vitamin K prophylaxis at birth for all newborns to prevent vitamin K deficiency bleeding (VKDB). Despite a lack of evidence for serious harms, barriers to prophylaxis, including parental refusal, are rising, as are cases of VKDB. Methods: This simulation involved an infant presenting to the emergency department who decompensated due to a cerebral hemorrhage caused by VKDB and was treated by pediatric and emergency providers. The case was incorporated into the fellow and division monthly curricula, and participants completed postsimulation surveys. The patient required a secure airway, seizure management, vitamin K, and a fresh frozen plasma infusion upon suspicion of the diagnosis, plus a coordinated transfer to definitive care. The case included a description of the simulated case, learning objectives, instructor notes, an example of the ideal flow of the scenario, anticipated management mistakes, and educational materials. Results: The simulations were carried out with 48 total participants, including 40 fellows and eight attendings, from five different training institutions over 1 year. In surveys, respondents gave overall positive feedback. Ninety-four percent of participants gave the highest score on a Likert scale indicating that the simulation was relevant, and over 80% gave the highest score indicating that the experience helped them with medical management. Discussion: This simulation trained physicians how to recognize and treat a distressed infant with VKDB. The case was perceived to be an effective learning tool for both fellow and attending physicians.
Introduction: The American Academy of Pediatrics recommends vitamin K prophylaxis at birth for all newborns to prevent vitamin K deficiency bleeding (VKDB). Despite a lack of evidence for serious harms, barriers to prophylaxis, including parental refusal, are rising, as are cases of VKDB. Methods: This simulation involved an infant presenting to the emergency department who decompensated due to a cerebral hemorrhage caused by VKDB and was treated by pediatric and emergency providers. The case was incorporated into the fellow and division monthly curricula, and participants completed postsimulation surveys. The patient required a secure airway, seizure management, vitamin K, and a fresh frozen plasma infusion upon suspicion of the diagnosis, plus a coordinated transfer to definitive care. The case included a description of the simulated case, learning objectives, instructor notes, an example of the ideal flow of the scenario, anticipated management mistakes, and educational materials. Results: The simulations were carried out with 48 total participants, including 40 fellows and eight attendings, from five different training institutions over 1 year. In surveys, respondents gave overall positive feedback. Ninety-four percent of participants gave the highest score on a Likert scale indicating that the simulation was relevant, and over 80% gave the highest score indicating that the experience helped them with medical management. Discussion: This simulation trained physicians how to recognize and treat a distressed infant with VKDB. The case was perceived to be an effective learning tool for both fellow and attending physicians.
Authors: Karen L Lewis; Carrie A Bohnert; Wendy L Gammon; Henrike Hölzer; Lorraine Lyman; Cathy Smith; Tonya M Thompson; Amelia Wallace; Gayle Gliva-McConvey Journal: Adv Simul (Lond) Date: 2017-06-27