Safe at Home

In a hospital setting, emergencies are not unexpected. Everything is in place to respond appropriately: a crash cart, a well-rehearsed protocol, an entourage of staff to assist if need be and back-up generation in case of a power outage.

In a home setting, however, there may be only one care provider. And there's no code button to push for immediate help if something goes wrong and the child's life is in danger.

As more and more medically fragile children are discharged to the home — thanks to advances in technology and a growing realization that they will do better there than in a hospital — it's essential to ensure that their care not be compromised and that the family environment is as safe as possible.

Pediatric Home Service, a St. Paul, Minn.-based organization that provides specialized health care service to technology-supported children in their homes, has a robust education component for home caregivers, including hands-on training on equipment, supplies, medications, procedures, and emergency response and troubleshooting.

A couple of years ago, staff members began to notice an increase in the number of “panic” calls from providers who were caring for PHS patients — particularly from those caring for patients with tracheostomies — indicating they didn't fully understand equipment use and emergency protocols.

PHS staff found themselves doing more and more troubleshooting and unscheduled home visits, responding to statements such as “I've never changed the circuit on the ventilator. The day nurse does that.” Or, “I didn't think to check the oxygen because we never use it.”

As a result, the company conducted in-home assessments of caregivers' essential skills relating to equipment and supplies to determine what educational materials and interventions were needed.

Evaluating Skills

PHS created a 37-item survey that included questions aimed at assessing the caregiver's knowledge of proper equipment setup, oxygen safety and use, emergency resuscitation bag (AMBU bag) function and use and emergency response procedures.

The survey, which was administered by PHS clinicians, was targeted to patients who had a tracheostomy and also used a ventilator for respiratory support.

Eighty-five families participated in the survey. Caregivers included 17 family members, 24 RNs, 38 LPNs, one RCP and five PCAs.