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CAEP FEI | Neonatal Resuscitation Skills Training

In Featured Education Innovations (FEI) by Nicole Kester-GreeneLeave a Comment

A seasoned emergency physician, Dr. Jensens has not practiced resuscitating an infant since he was a resident and hasn’t actually participated in a neonatal resuscitation since he was a medical student. He notices a circulating departmental email asking for volunteers to help run an “in-situ” simulation session next week, with the topic of “Neonatal Emergencies.” Intrigued, he signs up…

For many, neonatal emergencies rank among the scariest patient presentations in the Emergency Department in large part because they are so rare. These types of scenarios–high-stakes, complex and uncommon–are ideal for simulation-based practice. Furthermore, many residency programs have introduced in-situ simulation where the simulation mannequins are taken from the simulation lab to the trauma bay to introduce higher fidelity to the scenario. This Feature Educational Innovation (FEI) was originally posted by the CAEP EWG FEI Team on October 17, 2014. A PDF version is available here. A CAEP cast is available here.

Name of Innovation
Interprofessional neonatal resuscitation skills training for an ED team at an urban, academic hospital
Lead Innovator
Nicole Kester-Greene
Division or department’s website
Description of the Innovation

Interprofessional neonatal resuscitation skills training for an ED team at an urban, academic hospital using in-situ simulation

Overview
Opportunities for emergency department (ED) staff to learn neonatal resuscitation skills in an interprofessional environment are limited. We describe here a novel in-situ interprofessional simulation-based training exercise designed as a targeted, accessible and effective way to close this educational gap.
Educational objectives
After participating in the team training exercise participants will be able to:
1. DEMONSTRATE THE FOLLOWING NEONATAL RESUSCITATION SKILLS: 2.  DEMONSTRATE THE FOLLOWING ACTIONS/PRINCIPLES OF CRISIS RESOURCE MANAGEMENT:
  1. Perform initial assessment of a neonate in distress
  2. Perform positive pressure ventilation
  3. Perform chest compressions
  4. Obtain intravenous access in a neonate
  5. Perform the sequence of reassessments and interventions in a neonate
  1. Call for help early
  2. Clear closed-loop communication
  3. Identify a leader and maintain role clarity
  4. Anticipate, share and review your plan
  5. Distribute the workload, monitor and support team members
Background
In September of 2010, Sunnybrook Health Sciences Centre (SHSC) opened a Neonatal Intensive Care Unit (NICU) on its central campus. Historically, SHSC has served primarily an adult population.1 In 2008/2009, paediatric volumes at SHSC were less than a tenth of average paediatric volumes at other hospitals in the Greater Toronto Area.2 In a recent published study, 67.3% of ED staff at SHSC rated their neonatal resuscitation skills and sense of preparedness.3 Staff members’ self-reported knowledge, skills and neonatal resuscitation experience were self-rated as poor or very poor on a 5-point Likert scale. Furthermore, comfort with neonatal resuscitation and sense of preparedness for the critically ill infant was poor or very poor. These findings are concerning because all practitioners in the SHSC ED must be able to respond to a neonatal emergency. Given the multidisciplinary nature of the ED, simulation-based education, designed with interprofessional collaboration in mind, is well-suited for delivering continuing education to improve staff members’ neonatal resuscitation skills.
Methods
Capitalizing on the principles of situated learning theory, an in-situ, interprofessional, neonatal resuscitation skills simulation-based training exercise has been developed. Situated learning theory stipulates that learning is inextricably tied to the context in which it is learned.4 Hence, in-situ simulation whereby learning takes place in the real clinical environment using the same equipment and supplies used for real patients is ideal for clinical teams striving to advance practical skills.5 The educational offering will consist of regular, one-hour team simulations held during the established departmental continuing education rounds event. All ED staff including physicians, registered nurses and physician assistants are invited to participate. The first 30 minutes will be dedicated to hands-on skills practice with a task trainer and a neonatal mannequin (NeoNatalie, Laerdal Medical) in which learners may practice assessment, positive pressure ventilations and chest compressions. The next 30 minutes will consist of a 10-minute team neonatal resuscitation exercise followed by a 20-minute team debriefing session. Four learners function as a team to perform the initial steps of basic neonatal resuscitation using the NeoNatalie mannequin. To improve contextual fidelity, a computer monitor will display simulated vital signs and broadcast the typical auditory alerts of a cardiorespiratory monitor. Learners not actively participating in the resuscitation may observe via a video feed from a neighbouring conference room. The subsequent team debriefing will take place in the conference room. The facilitator will utilize the previously published advocacy-inquiry technique of debriefing to guide learners through three phases of debriefing: reaction, exploration and summarization.
Results
The educational effectiveness of the team training simulation intervention will be assessed according to Kirkpatrick’s framework for program evaluation. Learner satisfaction will be assessed through completion of a post-simulation evaluation. Evaluations will also assess learner’s perceptions of knowledge and skills retention and perceived impact on individual and team clinical practice.
Implications
Previous research shows that interprofessional, simulation-based training improved participants’ perceptions of preparedness for paediatric resuscitation.5 The impact of this interprofessional, neonatal resuscitation training exercise will be evident once learner’s evaluations are reviewed. Ideally, the improvement of patient outcomes is the ultimate goal of such an educational intervention but is much harder to demonstrate. That being said, unlike traditional didactic forms of continuing medical education, this is a novel interprofessional simulation-based intervention that increases the opportunity for ED staff to advance their practical skills.
References
  1. Sunnybrook Health Sciences Centre welcomes the Women and Babies program. Toronto: Canada Newswire; 2010.
  2. Canadian Institute for Health Information. Child Health Network Emergency Task Force: emergency departments and children in Ontario. In: CIHI analysis in brief. Ottawa Canadian Institute for Health Information; 2008.
  3. Kester-Greene N, Lee JS. Preparedness of urban, general  emergency department staff for neonatal resuscitation in a Canadian setting. CJEM 2014;16(5):414-420.
  4. Paige J, Daley B. Situated Cognition: A Learning Framework to Support and Guide High-fidelity Simulation. Clinical Simulation in Nursing 2009;5:e97-e103.
  5. Allan CK, Thiagarajan RR, Beke D, et al. Simulation-based training delivered directly to the pediatric cardiac intensive care unit engenders preparedness, comfort, and decreased anxiety among multidisciplinary resuscitation teams.  J Thorac Cardiovasc Surg. 2010;140 (3):646-652.

Has your shop introduced in-situ simulation? Do staff regularly participate? Given that the scenarios are much more public than in the simulation lab, do participants still feel that it is a safe learning space?

More About the CAEP FEI

This post was originally authored for the Canadian Association of Emergency Physicians (CAEP) Feature Educational Innovations project sponsored by the CAEP Academic Section’s Education Working Group and edited by Drs. Teresa Chan and Julien Poitras. CAEP members receive FEI each month in the CAEP Communiqué. CanadiEM will be reposting some of these summaries, along with a case/contextualizing concept to highlight some recent medical education literature that is relevant to our nation’s teachers.

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Nicole Kester-Greene

Nicole Kester-Greene

Nicole is clinician-teacher and associate professor in the Department of Medicine, Division of Emergency Medicine at the University of Toronto. She is Director of Emergency Medicine Simulation at Sunnybrook Health Sciences Centre and co-chair of the University of Toronto Educators in Emergency Medicine (UTEEM) group.
Nicole Kester-Greene

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