Newborn Nursery Emergencies: Simulating the First Five Minutes - Abstract
Objective: To provide training in the immediate response to newborn emergencies in a Level 1 newborn nursery, to assess the efficiency of this training for increasing the comfort level of pediatric residents and nurses in emergency recognition and response, and to identify systems issues that pose potential barriers to optimal patient care.
Patients and methods: Two simulation cases were designed and implemented monthly. Case 1 was respiratory distress and apnea. Expected management included recognition of respiratory distress/apnea, calling for assistance, and effectively performing bag valve mask ventilation. Case 2 was a seizure related to hypoglycemia. Expected management included checking blood glucose level, inserting an intravenous catheter, and administering intravenous dextrose. Debriefing occurred after each scenario focusing on management, barriers to care and inter-professional communication. Pre- and post-training, participants completed surveys assessing comfort level with newborn medical emergencies.
Results: Over a 10-month period, 40 learners (18 resident physicians (MD)/22 nurses (RN)) participated in training. There was a statistically significant improvement in perceived comfort level out of 5 from 3.74 ± 0.7 to 4.48 ± 0.42 (p <0.0001) for residents and nurses. Overall average confidence was higher for nurses than residents (4.26 ± 0.75 versus 3.89 ± 0.75; p = 0.02) both pre- and post simulation. Learning themes included: emergency response process (n=11), teamwork focus (n=10), seizure management (n=10), and effective bag valve mask ventilation/troubleshooting (n=7). Training was successful in identifying nursery systems issues including a deficit in pediatrics resident knowledge of the hypoglycemia protocol and staff inability to locate the pediatric code cart and infant code button.
Conclusions: Training of newborn nursery staff in the recognition and management of rare, newborn emergencies through simulation was successful in improving comfort level and identifying systems issues and strategies for improvement.