23-Translational Simulation Improves Compliance With the NEAR4KIDS Airway Bundle Checklist
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Pediatrics, Professional Development and Education, 2021
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The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Jordan W. Newman


Introduction/Hypothesis: The NEAR4KIDS Airway Bundle Checklist is a quality improvement tool that aims to improve the safety of TI. However many barriers to bundle adherence exist. Simulation-based educational interventions have successfully improved compliance with safety bundles and reduced errors. We utilized a translational simulation approach to identify and remediate barriers that contributed to poor compliance. We hypothesized that a simulation-based educational intervention aimed at the integration of the QI bundle checklist at the bedside would be associated with an increased use of the checklist and a decrease in tracheal intubation associated events.

Methods: This was a single-center retrospective review following multi-disciplinary translation simulations aimed at improving compliance with the NEAR4KIDS Airway Bundle Checklist. Primary outcomes were defined as adherence to a QI bundle checklist: compliance and utilization of apneic oxygenation during tracheal intubations. The secondary outcome was the occurrence of adverse tracheal intubation associated events.

Results: Overall 180 learners including 19 pediatric critical care medicine (PCCM) fellows, 4 critical care nurse practitioners, 127 nurses, and 30 respiratory therapists participated in simulations. Compliance with the QI bundle checklist and rates of TIAEs were collected for 12 months prior to simulation and 9 months following simulation. A total of 244 TIs pre-intervention and 158 post-intervention were collected. Adherence to the QI bundle checklist was 66% before simulation and 93.7% post-intervention (p < 0.001). Six months into the intervention and significant month to month to month change were noted. Adherence to apneic oxygenation was 27.9% prior to simulation and 77.9% post-intervention (p < 0.001). There was no difference in the occurrence of any tracheal intubation associated events.

Conclusions: Translational simulation was used as a safety tool used to improve NEAR4KIDS QI bundle checklist compliance and elucidate factors that contributed to successful implementation. Through simulation, we optimized bundle customization through process improvement, fostered a culture of safety, and effectively engaged multidisciplinary teams in this quality initiative as a means to improve adherence to best practice surrounding tracheal intubations.


Meta Tag
Content Type Presentation
Knowledge Area Pediatrics
Knowledge Area Professional Development and Education
Knowledge Level Advanced
Membership Level Select
Tag Simulation
Tag Healthcare Delivery
Year 2021
translational simulation
Near for Kids
airway bundle checklist
pediatric intensive care unit


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