As we live and breathe – the use of simulated education in the management of patients on continuous positive airway pressure (CPAP) with COVID-19 using both a high-fidelity manikin and a real person
Authors: Hargraves Dawn , Tatton Scott 
Published: November 2022

Continuous Positive Airway Pressure (CPAP) was being used on patients within designated wards to help reduce pressures on the Intensive Care Unit [1] and the number of intubated patients. Those patients presenting with COVID-19 associated respiratory failure within 48 hours of diagnosis were placed on CPAP [2]. The aim was to reduce mortality from hypoxaemia and promote patient safety. Those eligible for CPAP showed deterioration in oxygenation on arterial gas sampling or were showing increased work of breathing including an unsustainably high respiratory rate [3]. The simulated education sessions were to upskill registered intermediate care nurses in the use of CPAP, our most advanced airway procedure outside of the intensive care unit, and support redeployed nurses rostered onto the COVID-19 wards from other non-COVID-19 clinical areas. The aim was to empower nurses to feel more confident in the management of patients requiring CPAP and for them to be able to troubleshoot common problems giving patients the best care and chance of survival.

Methods included coordinating exposure for each nurse to a CPAP preloading session following Trust policy, proformas and competency, then ensuring clinicians attended a dedicated two-hour practical simulation-based session using a mixture of high-fidelity manikins and real persons as simulated patients. Scenarios were developed based on issues that had previously happened or could occur in clinical practice. This created both a progressive simulation or shorter sessions followed by a debriefing depending on the experience of the nurse and how they performed on the day. Staff were asked to complete a feedback form about how they found the session and then assessment was made in clinical practice with the signing off of the CPAP clinical competency

Within two months the team delivered training to all nurses rostered onto the COVID-19 ward and 95% had the clinical competency signed off. The feedback following the debriefing sessions stated that they felt more confident in managing the CPAP machine and the patient. They felt that the educational processes now in place facilitated patient safety and improved the quality of care delivered.

Simulation-based education with the CPAP machine improved not only theoretical but also practical knowledge to help staff feel more empowered and confident when in clinical practice. Using a real person for several of the scenarios instead of the manikins meant staff could experience and respond appropriately to situations as they developed. This not only improved realism but enabled more immersive experiences for all involved.

1. Vaschetto R, Barone-Adesi F, Racca F, Pissaia C, Maestrone C, Colombo D, Olivieri C, De Vita N, Santangelo E, Scotti L, Castello L. Outcomes of COVID-19 patients treated with continuous positive airway pressure outside the intensive care unit. ERJ Open Research. 2021;7(1).

2. Ashish A, Unsworth A, Martindale J, Sundar R, Kavuri K, Sedda L, Farrier M. CPAP management of COVID-19 respiratory failure: a first quantitative analysis from an inpatient service evaluation. BMJ open respiratory research. 2020;7(1):e000692.

3. Talbot-Ponsonby J, Shrestha A, Vijayasingam A, Breck S, Motazed R, Raste Y. Adaptation of a respiratory service to provide CPAP for patients with COVID-19 pneumonia, outside of a critical care setting, in a district general hospital. Future Healthcare Journal. 2021;8(2):302–306.