Abstracts
67
IS SIMULATION AN EFFECTIVE WAY TO TEACH
COMMUNICATION IN NEONATAL-PERINATAL MEDICINE?
K Godin*, E Finan, A Jefferies, B Simmons, A Keir
University of Toronto, Toronto, Ontario
BACKGROUND: Effective communication between neonatologists and
families is essential to family-centered care. Neonatal-Perinatal Medicine
(NPM) training, however, focuses on knowledge acquisition, rather than
communication skill development. Presently, there is no standardised
approach to communication skills training in Canada.
OBJECTIVES: The purpose of this project was to develop, implement
and evaluate a simulation based communication skills workshop for
Neonatal-Perinatal Medicine trainees.
DESIGN/METHODS: A questionnaire to assess current communication
teaching methodology and trainee confidence was sent to NPM program
directors and trainees across Canada. A workshop that included both
didactic teaching and simulated parent encounters was then developed
based on deficits identified in the needs assessment. Trainee communication skills were assessed in pre and post workshop scenarios using qualitative (Calgary-Cambridge – CC) and quantitative (Global Rating Scale
– GRS) assessment tools. One month later, trainees participated in another
simulated encounter to evaluate retention. Trainees completed questionnaires pre and post workshop, as well as one month post workshop to assess
perceived confidence, communication skills and workshop satisfaction.
RESULTS: Two thirds of training programs do not offer formal communication skills training. Eight trainees completed the workshop; four of these
completed the retention assessment. Five trainees improved on both the
GRS and CC with mean scores (sd) increasing from 29.6 (±1.8) to
33 (±2.4) out of 45 and 83.1 (±2.6) to 89.9 (±3.0) out of 100, respectively.
At the one month post assessment, three trainees were equivalent to, or
improved from, their post workshop assessment with scores of 35.3 (± 1)
and 95.2 (±1.7). In pre vs. post workshop surveys, there were trends
towards increasing confidence in discussing palliative care (33.3% vs.
77.8%), conflicts of opinion (44.4% vs. 66.7%) and religious or spiritual
beliefs (33.3% vs. 66.7%). Seven of eight trainees “agreed” or “strongly
agreed’ that the workshop met their expectations and all “agreed” or
“strongly agreed” that the workshop improved their communication skills.
CONCLUSION: The implementation of a simulation based communication skills workshop resulted in improved confidence amongst trainees and
improved qualitative and quantitative assessments in almost two-thirds of
cases. Similar workshops should be implemented to enhance communication skills teaching across Canadian NPM programs.
68
IMPACT OF A DEDICATED RESUSCITATION ROOM ON
STABILIZATION TIME AND QUALITY OF CARE IN
PRETERM INFANTS
S Gupta*, S Shivananda
Burlington, Ontario
BACKGROUND: Resuscitation rooms, which are separate areas from
delivery and operative rooms, are environments that are specially designed
to provide adequate space for resuscitating and stabilizing newborn infants.
OBJECTIVES: The primary objective of our study was to assess the
impact of having a dedicated resuscitation room (infant stabilization room,
ISR), on time to full stabilization and quality of care.
DESIGN/METHODS: We conducted a prospective cohort quality
improvement study at a level three perinatal centre. All infants less than
33 weeks gestational age were included. The study was conducted over a
period of three years (February 2011 to June 2014), and was divided into
four phases – pre-implementation phase (February 2011 to Jan 2012),
implementation phase (Feb 2012 to July 2012), post-implementation
phase (August 2012 to July 2013) and sustainability phase (August 2013
– June 2014). ISR was successfully commissioned in February 2012.
Workflow, design, equipment, staffing, stocking and roles of caregivers
were modified and tested using simulation, in-servicing and education over
multiple PDSA cycles. Patient health records were reviewed for frequency
of interventions and time to complete interventions; intubation, umbilical
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or peripheral vascular catheters, initial imaging, surfactant and time to full
stabilization. Impact on quality and teamwork were assessed by participant
observation and focus groups at multiple time points.
RESULTS: Total number of preterm infants included in the study was 769;
233, 102, 244 and 190 infants in phases 1 to 4 respectively. The mean gestational age (29 weeks), mean birth weight (1300 g) and gender distribution
were similar across all the four phases of the study. The time to full stabilization reduced from 88 minutes in the pre-implementation phase to 73 minutes in the post-implementation phase. Similar reductions were noted in the
time to intubation, insertion of vascular catheters, surfactant and x-rays. The
number of resuscitations occurring in the infant stabilization room increased
over the course of the study. The ISR provided more space and avoided overcrowding. Resuscitation and stabilization were able to occur as a continuum.
One baby, one bed and one ventilator strategy for the first 48 hours promoted
minimal handling of the infants. Parents experienced less chaos and anxiety,
were able to attend resuscitation in the ISR and the mother was able to see
the infant before being transferred to NICU.
CONCLUSION: Having a dedicated resuscitation room tends to decrease
time to interventions, stabilization time and improves teamwork and quality
of care.
69
IDENTIFYING RISK FACTORS FOR UNPLANNED
EXTUBATIONS IN THE NICU: LAYING THE GROUNDWORK
FOR A QUALITY IMPROVEMENT INITIATIVE
M Hewitt*, E Sproul, J Emberley
Memorial University of Newfoundland, St John’s, Newfoundland
and Labrador
BACKGROUND: Unplanned extubations (UEs) are a common adverse
event experienced by ventilated neonates in the Neonatal Intensive Care unit
(NICU) and can lead to significant morbidity in an already vulnerable population. Despite the fact that UEs are increasingly recognized as an important
quality of care metric, this adverse event was not being routinely reported at
our institution. We sought to determine the rate of UEs in this NICU and
identify risk factors to target future quality improvement interventions.
OBJECTIVES: 1. To determine the rate of UEs (# of UEs/100 ventilator
days) in a level II/III NICU; 2. To identify risk factors associated with UEs.
DESIGN/METHODS: Institutional ethics approval was obtained prior to
start of the study. A retrospective chart review was conducted for all intubated neonates admitted to a 34 bed level II/III NICU from January 1st,
2013 until December 31st, 2013. An UE was defined as any removal of an
endotracheal tube not directly ordered or intended by a physician. For each
UE event, the following data were collected: gestational age, birth weight,
gender, weight at time of extubation, time at which event occurred, reason
for extubation, and total number of ventilation days.
UE rate was calculated by #UEs/100 ventilator days. Reasons for UEs were
expressed by Pareto charting. Multivariate regression analysis was performed for gestational age, birth weight, and total ventilation time. Timing
of event was categorized as either day or night shift and analyzed for significance using ANOVA.
RESULTS: The UE rate was 3.28 UEs/100 ventilator days. Patient movement and adhesive failure accounted for over 50% of UEs. In 22.7% of
cases, patients did not require re-intubation. Total ventilation time was the
only statistically significant risk factor for UEs with a 7.3% increased risk
per ventilation day past the mean. UEs were no more likely to occur on day
versus night shift, nor were there any significant differences in the reasons
for UE based on shift.
CONCLUSION: The UE rate at this institution was higher than the suggested benchmark. More than 20% of patients did not require reintubation, reinforcing the need for more aggressive weaning protocols.
Interestingly, night versus day shift was not found to be a significant risk
factor. Total ventilation days independently predicted UE risk; pre-emptively identifying such patients is a potential avenue for future quality
improvement interventions.
Paediatr Child Health Vol 20 No 5 June/July 2015