When A Pandemic Hands you Lemons, Make Lemonade: Just In Time Simulations to Ensure Ongoing Competency and Proficiency for Neonatal Emergencies (1090-003583) (Research Abstract Professor Rounds: Group 5)
Start time: Friday, January 29, 2021, 10:00 AM End time: Friday, January 29, 2021, 11:00 AM Session Type: Research Abstracts (Completed Studies)
Skill degradation is a significant concern for high risk low volume procedures. Learning from the aviation and space industry1, healthcare professionals have utilized simulation to prevent skill degradation2-4. With the onset of a novel coronavirus pandemic many hospitals shifted ambulatory and well patient services such as obstetrics in an effort to prepare for the expected surge of the acutely ill. One local facility experienced a similar shift in obstetrical services, resulting in a sharp decrease in delivery volume. We strategized for a solution to ensure ongoing proficiency and competency for neonatal resuscitation through Just in Time (JIT) Simulations. We hypothesized through the use of JIT simulations, we could provide unique simulation based education in 1) standardized preparation of basic delivery resuscitation equipment through behavioral and cognitive learning and 2) skill performance with directed JIT feedback for airway recovery and troubleshooting interventions.
Two cycles of Just in Time Simulation were conducted from May 1-20, 2020. A total of 154 simulations were conducted over the two cycles (80 and 71 for cycle 1 and 2 respectively). These simulations were conducted with individual staff members and a dedicated facilitator due to social distancing concerns. Staff members participated multiple times during the course of the 2 cycles to hardwire behaviors and knowledge. The initial cycle focused on a standardized approach to preparation for basic resuscitation equipment. There were five basic items deemed essential for all delivery resuscitations, with a focus on thermoregulation, airway clearance and recovery. The second cycle focused on the initial stages of NRP through airway recovery and troubleshooting measures. A Likert Scale pre and post self-assessment was completed by all participants regarding their knowledge and confidence level for skills and information disseminated in the JIT Simulations.
Improvement in skills/knowledge during Cycle 1 for L&D and Couplet staff were noted in the use of the T-Piece resuscitator, appropriate oxygen concentration and methods for heat loss. L&D nurses showed a 27% and 34% improvement in knowledge for appropriate oxygen concentrations (term & preterm respectively) and a 20% improvement in methods of heat loss. Couplet nurses showed 33% improvement in confidence regarding T-Piece set-up, adjusting pressures and appropriate oxygen settings. Lastly, they reported a 23% improvement in knowledge regarding methods of heat loss. Cycle 2 results identified more opportunities for growth in NRP skills. Significant improvement from L&D and Couplet staff was noted in 4 areas: basic questions to be addressed prior to deliveries (31% and 33% respectively), initiating PPV (27% L&D), standardized phraseology for heart rate (28% and 33% respectively) and chest rise (32% and 33% respectively) and troubleshooting techniques for ineffective PPV (33% for both).
Just in Time simulations can be a useful methodology to provide rapid-fire, targeted education. By providing multiple opportunities for learning with directed feedback, confidence and skill level improved. Follow up evaluations will be conducted to assess for knowledge retention with subsequent follow up JIT simulations based on the knowledge gaps identified. Further simulations are needed to demonstrate translation to retained skill with the incorporation of additional members of the resuscitation team.