Teaching Families How to Manage Diabetic Emergencies Using Their Children as Patient Simulators

Abstract

Objectives The aims of the study are to develop an insulin pump simulation curriculum using patients as simulators, to evaluate its effectiveness on knowledge, attitudes, and skills necessary for families to manage diabetic emergencies, and to identify ongoing gaps in care. Methods Our simulation curriculum developed using Kerns, consisted of 4 stations. A prospective simulation study was conducted at a pediatric tertiary care hospital with a convenience sample of children with type 1 diabetes on the insulin pump program and their families using patients as simulators and their parents as participants. The curriculum's success with developing competent skills was assessed using Kirkpatrick's 4-level evaluation model. Data from satisfaction questionnaires, performance gaps in emergency management, and postsimulation knowledge questionnaires were analyzed to identify ongoing gaps in care using a mixed methods approach. Results Among 70 families (169 participants), satisfaction was high (3.7–4.0/4.0) and confidence was increased (mean score 12 ± 0.03/12). Recurrent performance gaps across scenarios were found: misunderstandings about residual insulin during hypoglycemia (35%) and severe hypoglycemia with altered level of consciousness (22%), and failure to identify causes in 13% of simple and 11% of severe hypoglycemia scenarios and overtreating hypoglycemia with glucagon in a conscious patient in 14% of simple hypoglycemia scenarios. Postsimulation knowledge questionnaires revealed improvements in knowledge/management of simple hypoglycemia (mean score 87%), poor knowledge of pump parameters (mean score 56%), excellent knowledge of manipulating pump parameters to prevent emergencies (mean score 100%), and poor knowledge of basal rate concepts (mean score 19%). Conclusions Simulation using patient simulators improved management skills and confidence of families facing diabetic emergencies. Ongoing gaps in care were identified and used to enhance the current curriculum. Integrating simulation into insulin pump curricula can enhance patient self-care, safety, and be generalizable to other chronic-care patient-education programs. Future work should evaluate the impact of this curriculum on real-life events and patient outcomes.