Background: Nurses serve as frontline providers at low risk deliveries, and are responsible for assessing the newborn, providing initial steps (IS) and if needed, starting bag mask ventilation (BMV) and calling for help. There are limited data on optimal methods of discipline specific training in these skills. We piloted a SIM refresher course focusing on the initial portion of NR prior to arrival of larger team.
Objective: Evaluate the efficacy of a NRP refresher course on nursing performance of IS (warm, dry, stimulate, suction), calling for additional help, initiation of BMV and performance of ventilation corrective steps: adjust mask (M), reposition head (R), suction airway (S), open mouth (O) & increase pressure (P) (MRSOP).
Design Methods: A refresher course was piloted in Fall 2019 in a large delivery service among labor and delivery (L&D) and neonatal intensive care unit (NICU) nurses. The brief 15 min, one-on-one course was developed by a multidisciplinary team and is comprised of 3 parts. 1. Sim 1 (pre-teaching) to establish baseline skills. 2. Debrief to provide specific feedback, teaching and opportunity to practice. 3. Sim 2 (post-teaching) to solidify learning. Individual performance during each SIM was recorded by an instructor on a novel NeoNatalie Advanced manikin (Laerdal Medical) using a control iPad. A readout allows the instructor to provide real time feedback and to obtain quantitative data of performance. Data was scored to indicate completion of: IS, call for help, initiating BMV, performance of MRSOP, and consideration for alternative airway (Table 1). McNemar's & paired t-tests were utilized for analysis. This is an IRB approved study.
Results: 68 L&D/NICU nurses were included in this study. Mean total performance scores were higher in Sim 2 versus Sim 1 (15.0 vs 7.2; p < 0.001) (Fig 1). In Sim 2 vs Sim 1 participants were more likely to call for help (94.1% vs 41.2%; p <0.001). Almost all participants initiated BMV in Sim 1 and Sim 2 (95.6% vs 100%, p=0.25 respectively). More participants performed at least one step of MRSOP (100% vs 88.2%; p= 0.008) and all of MRSOP (38.2% vs 1.5%; p < 0.001) in Sim 2 vs Sim 1 (Table 2).
Conclusions: Implementation of a brief nursing-specific NRP SIM refresher course significantly improves performance of initial resuscitation skills from baseline. The observation of low baseline scores suggests an urgent need for more frequent refresher courses to achieve and maintain mastery of NRP skills.
