678 Body shapes don’t define a patient, so why does it affect basic life support? An in-situ simulation scenario on choking for a child with an altered body shape

Abstract

<h3>Background</h3> A recent article published in Nursing Children and Young People outlined how basic life support needs to be adapted for children with altered body shapes (Thomas, 2020). Paediatric basic life support (BLS) courses do not include information on how algorithms, such as choking or chest compressions, can be amended for patients with anatomical deformities to ensure that high quality basic life support can still be delivered. <h3>Objectives</h3> The main focus of this simulation was to understand that children with altered body shapes and complex medical needs may not tolerate standard back blows or abdominal thrusts, and how to amend both of these techniques in such instances. <h3>Methods</h3> We developed an in situ simulation case, whereby a 10 year old child with spastic quadriplegia and scoliosis presents in our paediatric assessment unit with respiratory distress. As the medical team begin to assess the patient, he vomits and then starts choking. Candidates are expected to recruit help by pulling the bedside alarm, and then begin using the choking algorithm to attempt to dislodge the obstruction. We used a Diamond Debrief model to debrief candidates and used written feedback, in the form of free text responses and rating scales, to ascertain if the candidates found the session beneficial to their learning. <h3>Results</h3> There were 7 candidates ranging from a trainee nurse practitioner, junior doctors in training and clinical fellows. The average confidence in dealing with this scenario increased from 2.5 to 4.2 (whereby 1 denotes very low confidence and 5 represents very high confidence). Every candidate commented that the scenario had helped them to understand how to amend the BLS algorithms in view of altered body shapes. <h3>Conclusions</h3> This in situ simulation highlights the importance of addressing how techniques and guidance delivered in BLS courses has to be tailored to the child or young person, and yet, is not necessarily discussed in clinical areas. The impact of this scenario demonstrates the power of using in situ simulation to address gaps in collective team knowledge and experiences, and how guidance needs to be written to be inclusive and to maintain quality of care for all patients who use our services. We aim to run this and similar simulation scenarios involving children with altered body shapes in order to constantly develop the multidisciplinary team skills.