Leveraging our resuscitation data to improve patient care in neonates

Purpose:
To improve delivery room management by increasing the proportion of cases where all of the following were done: team composition compiled with unit guidelines, briefing and debriefing were performed, and family communication occurred immediately following delivery.

Relevance/Significance:
Data showed us that we had opportunities for improvement related to delivery room management. Specifically briefing and debriefing of scenarios encountered, and team composition. Utilizing multiple PDSA cycles we were able to successfully standardize our practices and improve patient outcomes. Working with a nursing staffing matrix, the unit was able to assign a dedicated nurse 24/7 to the delivery room. Team performance was improved through standardized interdisciplinary education.

Strategy and Implementation:
Current NRP training is required of all clinical staff. A skills lab was created in the NICU for procedural training of residents using a Boot Camp training approach as well as 2-3 scheduled MOCK codes per month using standardized patients with an interdisciplinary team in our simulation center with certified simulation instructors. Portable resuscitation bags with standardized contents and location are used for all delivery room codes. The resuscitation team is identified during the unit brief at the beginning of each shift in addition to Safety huddles attended by L&D and NICU clinical staff to review pending deliveries including staffing adequacy and high risk patients. A delivery room triage algorithm identifying required team members based on clinical criteria with Levels I–IV was developed and disseminated to NICU and L&D. Briefing and debriefing are required for all delivery room calls. Resuscitation team diagrams were placed on each warmer to facilitate team roles.

Evaluation:
Our Neonatal Resuscitation code team recently received the Silver Achievement Award from the American Heart Association. The award reflects 12 consecutive months at 85% or higher compliance on the resuscitation achievement measures. The implementation of the changes mentioned has standardized our resuscitation efforts, improved the efficiency and skill of our team and increased staff satisfaction.

Implications for Practice:
The DR triage algorithm empowered nurses to request an appropriate staff mix based on the clinical status of the patient. Clearly defining and assigning roles improved efficiency of the team. Safety huddles and unit briefs improved communication and increased confidence levels.