Canadian journal of respiratory therapy : CJRT = Revue canadienne de la thérapie respiratoire : RCTR
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Percutaneous tracheostomy is a common procedure in the intensive care unit and, on patient transfer to the wards, there is a gap in ongoing tracheostomy management. There is some evidence that tracheostomy teams can shorten weaning to decannulation times. In response to lengthy weaning to decannulation times at Trillium Health Partners - Credit Valley Hospital site (Mississauga, Ontario), an interprofessional tracheostomy team, led by respiratory therapists and consisting of speech-language pathologists and intensive care physicians, was implemented. ⋯ An interprofessional tracheostomy team can improve the quality of tracheostomy care through earlier tracheostomy tube changes and swallowing assessment referrals. The lack of improved weaning to decannulation time was potentially due to poor adherence with established protocols as well as a change in mechanical ventilation practices. To validate the findings from this particular institution, a more rigorous quality improvement methodology should be considered in addition to strategies to improve protocol compliance.
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Clinical simulation has become established as a commonly used educational approach in respiratory therapy, though questions remain with regards to the evidence basis for its use in some contexts. In conjunction with the development of a new iteration of the National Competency Framework (NCF), the National Alliance of Respiratory Therapy Regulatory Bodies (NARTRB) reaffirmed its desire to continue to recognize the use of simulation as an educational tool. Given the expressed uncertainty as to best practices in the use of clinical simulation in entry-to-practice respiratory therapy education programs, the NARTRB requested the creation of an expert workgroup to develop a list of recommendations from which an implementation plan could be developed for the next iteration of the NCF. ⋯ The recommendations indicate that the use of formative assessment in clinical simulations along with deliberate practice has been clearly shown to improve learning outcomes for which the simulations are designed. However, it is advised that the use of clinical simulation for the summative assessment of competency (e.g., to assess readiness for practice) be exercised cautiously in the context of respiratory therapy education. A number of requisite instructional design factors that should be considered before implementing summative simulation-based assessments are identified, including the validation of summative assessment tools.