|Year : 2018 | Volume
| Issue : 2 | Page : 67-70
Impact of the neoresus training on nonpediatric-trained medical and nursing staff in the emergency department: Experience from two sites in regional Australia
Anutosh Shee, Mandy Gleeson
Department of Paediatrics, North West Regional Hospital, Burnie, Tasmania, Australia
|Date of Web Publication||10-Apr-2018|
Dr. Anutosh Shee
North West Regional Hospital, 23 Brickport Road, Burnie, Tasmania
Source of Support: None, Conflict of Interest: None
Aim: We aimed to determine if a structured neonatal resuscitation program, advanced NeoResus, can effectively improve the confidence level of the nonpediatric-trained medical and nursing staff in the emergency department (ED) for providing neonatal resuscitation in the face of sudden, unexpected delivery. Materials and Methods: A self-reported questionnaire powered by Likert scale and open-ended questions, was used to evaluate the impact of the program on the ED staff in gaining confidence after completing the online and face-to-face parts of the program. Results: A total of 45 nonpediatric-trained multidisciplinary health-care professionals attended the program; out of those 24 were nurses/midwives. Before the course, 97% candidates had reviewed the online learning modules and 91% of them found them good or excellent. All ED staff agreed that the time allocated for practicing the use of airway adjuncts, manual ventilation devices, chest compressions, and umbilical venous line and the quality of information provided was adequate. All ED staff, again, either agreed or strongly agreed that participating in neonatal resuscitation scenarios had improved their confidence level in managing the neonatal emergencies. Conclusion: There was a very good compliance and acceptability of the course by the nonpediatric trained staff. All attendee felt more confident about acquiring the necessary knowledge and skill needed for neonatal resuscitation in emergent situation. A further follow-up study will be required to assess objectively about the knowledge acquisition and retention by the ED staff for ongoing provision of emergency neonatal resuscitation.
Keywords: Emergency department, endotracheal tube, Neonatal Emergency Transport Services, Neonatal Intensive Care Unit, Obstetricians and Gynecologists, Resident Medical Officer
|How to cite this article:|
Shee A, Gleeson M. Impact of the neoresus training on nonpediatric-trained medical and nursing staff in the emergency department: Experience from two sites in regional Australia. J Clin Neonatol 2018;7:67-70
|How to cite this URL:|
Shee A, Gleeson M. Impact of the neoresus training on nonpediatric-trained medical and nursing staff in the emergency department: Experience from two sites in regional Australia. J Clin Neonatol [serial online] 2018 [cited 2018 Apr 24];7:67-70. Available from: http://www.jcnonweb.com/text.asp?2018/7/2/67/229673
| Introduction|| |
Neonatal resuscitation can be a very frightening experience for the emergency department (ED) staff particularly if women in labor present unexpectedly and the imminent delivery must be dealt with by the nonpediatric-trained medical and nursing team in ED who have very limited exposure to neonatal resuscitation. We present our experience of implementation of a NeoResustraining program in two ED sites in regional Australia by analyzing postcourse, self-reported questionnaire to understand the level of confidence achieved by the ED staff in dealing with newborn resuscitation in sudden unexpected situations.
NeoResus (www.neoresus.org.au) is a neonatal resuscitation training program developed in Victoria, Australia for health-care professionals involved in newborn delivery. Conventionally, it has been accessed mostly by the pediatricians, neonatologist at their various training level and also to the midwives and neonatal intensive care unit nursing staff who are involved in everyday newborn care. It was piloted by Neonatal Emergency Transport Services education in 2010. The program combines web-based precourse learning materials complemented by a full-day face-to-face workshop that emphasize technical competence, teamwork, case scenarios, and debriefing. Materials are evidence-based and the program complies with the principles of adult learning. Focused skill areas include assessment of the newborn to determine resuscitation interventions required, practicing of “bag and mask” and T-piece (Neopuff™) ventilation device and external cardiac compressions. Advanced skills include endotracheal intubation and taping, umbilical venous catherization, and administration of medications. The clinical scenarios which include “peripartum hypoxia,” “meconium stained liquor,” “preterm infant,” and “antepartum hemorrhage” are specifically developed for this training program and required attendees to reflect on their real-life experiences in newborn resuscitation.
| Materials and Methods|| |
Closure of an inpatient obstetric unit due to the restructuring of one of the regional hospitals had compelled clinicians to anticipate continuation of the long-standing practice of the last moment presentation of women in labor in ED on the old site. Therefore, the need to prepare the ED staff for providing immediate neonatal resuscitation was strongly felt. The Advanced NeoResus program was offered to the medical and nursing staff of the two ED sites in two regional Australian hospitals in the last three years from February 2014. Clinicians targeted for the workshops included ED consultants, registrars and Resident Medical Officers (RMO), Obstetricians and Gynecologists (O and G) consultants, registrars and RMOs, interns, and ED nurses and midwives. The course coordinator sent out emails with the course details inviting all the prospective participants. The participants were qualified for a paid study day. Every program had a mix of medical and nursing staff. A prior learning of the precourse online resources was tracked. This included a knowledge quiz which generated a “certificate of completion” that was required to be submitted before the face-to-face course. On the course day, each of the didactic sessions which included basic science and some controversial area of neonatal resuscitation were followed by allocated extra time for open discussion. Four specific areas of skill were part of the program, which included application of face mask, “bag and mask” and T-piece ventilation (Neopuff™), external cardiac compressions, and endotracheal intubation on mannequin and insertion of umbilical venous catheter on the “real” human umbilical cord. This was collected from the labor unit after confirming the infection-free status and gaining consent from the mothers. Each candidate was supervised during the procedures and instant feedback was provided. At the end of skill competency, four resuscitation scenarios on “peripartum hypoxia,” “meconium stained liquor,” “preterm infant,” and “antepartum hemorrhage” were practiced on mannequin creating a multidisciplinary real-life type environment. The key areas of the focus include the communication, leadership ability, effective team player and ability to follow systematic approach. Everyone had an opportunity to be a team leader in at least on one occasion. At the end of the course, a questionnaire was completed. This questionnaire had a mixture of Likert styled closed-ended and some open-ended questions seeking about information on the demographics, feasibility and accessibility of precourse online resources, time and quality of the hands-on procedural skills and different aspects of the didactic lecture and clinical scenarios including the level of confidence gained after the course.
| Results|| |
A total of 45 nonpediatric trained multidisciplinary health-care professionals attended over the last 3 years from February 2014, of those 24 were nurses/midwives [Figure 1]. The remaining were the ED/O and G medical staff. There were two O and G registrars, 11 ED physicians/advanced trainee registrars and eight RMO/interns who attended the program. Evaluation response rate was 97.7%. The same percentage of candidates had reviewed the online learning modules and 91% of them found them to be good or excellent. Forty-four participants had watched the online video demonstration of Neopuff™ and ETT placement (97.7%), whereas slightly lower rate (84%) had reviewed the “pedi-cap™” use before the course, which is suggestive of a very good overall compliance rate [Figure 2]. All the ED staff had agreed that the time allocation for practicing manual ventilation devices and in assisting or doing the endotracheal tube insertion was adequate. Likewise, 100% of the staff either agreed or strongly agreed that the resuscitation scenarios enhanced their understanding of the interventions required in specific neonatal emergencies. All of them, again, either agreed or strongly agreed that participating in a neonatal resuscitation scenario had not only improved their confidence level to manage a neonatal emergency as a team member but also helped them to decide when to take leadership role during the resuscitation situation. About 93% of staff felt the time allocated after each scenario for debriefing and the quality of debriefing was very useful. All the ED staff reported they would recommend it to others ED staff.
Through the open-ended questions many areas have been indicated by the ED staff which suggested the change in their perception about the neonatal resuscitation following attending the course. The most common being the clarification of oxygen use in the preterm deliveries followed by the importance of individual's roles and responsibilities during the resuscitation. Many participants felt confident of “bag and mask” ventilation and about securing the ETT [Figure 3]. The need for the availability of printed copy of step-by-step neonatal resuscitation algorithm attached to the resuscitaire was expressed by many for ongoing practices in the ED. Some candidates commented they would now give more importance to systematic “assess and act” approach rather than rushing into the scene.
| Discussion|| |
The advanced NeoResus course has been known to be very effective in providing structure in the knowledge base and step-by-step approach for the neonatal resuscitation in pediatric-trained medical and nursing staff. In a large sample study in Melbourne, Whitelaw et al. found the comparable rate of feedback for midwives, nurse, and pediatric-trained medical and nursing staff. In between February and October 2012, 420 multidisciplinary health-care professionals attended 28 courses in 9 months. Evaluation response rate was 93%. As many as 88.5% of attendants had reviewed the online learning modules and 84% found them good or excellent and 96.3% would recommend it to others. This reflects the similar profile we have found in our study when the course is attended by the nonpediatric-trained staff. It was also assumed that the learning needs for our cohort of participants would be different from those of pediatric-trained staff. Our cohort does not have exposure to everyday newborn care in the NICU, therefore, lack of basic knowledge and regular hands-on experience of procedural skills such as strapping of the ETT, securing techniques of umbilical venous catheter, and preparing and complicated administration of medication in newborn babies were thought to be a huge obstacle in the effectiveness of the NeoResus program. Not surprisingly, therefore, strapping of ETT, securing umbilical lines, need for more focused adherence to algorithm, role and responsibility of each member during the resuscitation have come up as some of the most important aspects of the course which benefited the most. Most importantly, all of them have found that course attendance has improved their level of confidence.
This study has a very small sample size and only focused on if it has the potential in achieving confidence following attending the course. Further large prospective studies measuring the outcome on the knowledge acquisition, retention, and real-life performance by the ED staff need to be done before it can be offered to the ED staff in rural and regional centers without any in-house obstetric/pediatric support. However, this study has suggested advancedNeoResus has the potential to train nonpediatric trained staff in these areas. The advantage of this course, as felt by the candidates while answering the open-ended and closed-ended questions, includes a structured, concise, involving the most relevant procedural skill areas and clinical scenarios. The language of the online resource has been appropriately understood by the nonpediatric trained staff, too. Daily resuscitation equipment checks and maintaining, ensuring familiarity with the equipment and ongoing mock scenarios in the ED would be a way to complement in maintaining the standard of neonatal resuscitation, are some of the valuable opinions expressed by the participants. A follow-up study will need to be undertaken to review the performance of the ED staff for urgent neonatal resuscitation by eye-tracking approach.
| Conclusion|| |
This one-day short structured program can be very useful train nonpediatric trained ED staff, who need to deal with urgent deliveries in ED without any pediatric staff being present. The online resources are appropriately understood, required procedural skills are achievable and more importantly candidates feel more confident of running a neonatal resuscitation as a team player in the ED. This would have an impact the safety and quality of the healthcare in the hospital in the regional settings where adequately trained personnel may not be immediately available on site.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Whitelaw J, Thio M, Smith R. The Victorian Neoresus training program: Feedback from participants. Abstract from 17th
Congress of the Perinatal Society of Australia and New Zealand, Adelaide, Australia; 2013. p. 76.
Law BH, Cheung PY, Wagner M, van Os S, Zheng B, Schmölzer G, et al.
Analysis of neonatal resuscitation using eye tracking: A pilot study. Arch Dis Child Fetal Neonatal Ed 2018;103:F82-4.
[Figure 1], [Figure 2], [Figure 3]