Background
The National Resuscitation Program (NRP) has issued guidelines regarding delivery room tasks to be performed prior to newborn delivery. Successful resuscitation requires all necessary equipment and supplies in the delivery room, and inadequate preparedness has led to gaps in quality of care.
Objective
To improve the preparedness of the labor and operating rooms for neonatal resuscitation prior to newborn deliveries as highlighted by the NRP in an urban community teaching hospital. This assumes even more significance in the light of the current pandemic.
Design/Methods
NRP certified pediatric residents (PGY1) and nurses were eligible to collect data. When called for a delivery, they surveyed the labor and operating rooms, assessing the availability of all necessary equipment using a binary checklist for availability and function. Also, Quality Improvement (QI) meetings were held between the OB GYN and Pediatrics departments regarding patient care. Microsoft Excel was used to collect and analyze the data transferred from paper forms during Plan/Do/Study/Act (PDSA) cycle 1, which ran from May 2012 through December 2016. An electronic checklist was implemented in PDSA cycle 2 which ran from December 2017 through December 2019. The electronic checklist was intended to streamline the process, alleviating the need to manually calculate results as form responses were automatically populated into a database, decreasing the number of errors and time needed for data entry and calculation.
Results
Before introducing the checklist, no specific method of documenting equipment was required prior to newborn delivery. Preintervention data showed an average overall equipment preparedness rate of 80% for neonatal resuscitation, including 0% neonatal transport incubator present in cases of urgent transport to the Neonatal Intensive Care Unit (NICU). After cycle 2, incubator presence increased to 97%. Also, attendings can now access the data in real time for QI meetings to increase interdepartmental preparedness of labor and operating rooms. Checklist implementation and addressing issues at the QI meetings increased equipment preparedness rate to a mean of 93% in 30 months. Neonatal transport equipment has been present, warmed and ready with a compliance rate of 95%.
Conclusion(s)
By implementing our checklist and addressing the issues regularly at hospital QI meetings, we were able to improve the quality of patient care by achieving and maintaining >90% preparedness of all necessary equipment and supplies per NRP regulation in our labor and operating rooms prior to newborn deliveries.
