The Advanced Resuscitation of the Newborn Infant Course. Novel approaches to teaching and assessment - the ARNI experience

Transcription

1 The Advanced Resuscitation of the Newborn Infant Course Novel approaches to teaching and assessment - the ARNI experience

2 Background Standardised RC(UK) national course Builds on the RC(UK) Newborn Life Support Course Set up with support from BLISS Teaches technical, communication and human factor skills Multi-professional Candidates: Doctors -middle grade or above Advanced neonatal nurse practitioners Neonatal nurses > 2 years experience. Course manual

3 Edinburgh 2 days 16 candidates 8 instructors Up to 4 instructor candidates Manchester Birmingham Oxford Bristol

4 Assessment In order to pass, the aims of the ARNI course must be met: "be able to work effectively within a team to provide resuscitation or intensive care to a neonate "support staff in providing clear, open and sensitive communication with families"

5 Assessment "be able to work effectively within a team to provide resuscitation or intensive care to a neonate "support staff in providing clear, open and sensitive communication with families" Technical Non-Technical

6 Technical Non-Technical Practical, hands on skills e.g. intubation Communication Team working Human Factors

7 Course Content Interactive lectures Early assessment & management Human Factors Skill stations Mask leak Advanced airway Workshops Communication Chest drains Therapeutic hypothermia Simulations 8 common neonatal emergencies

8 Technical / non-technical components Technical Non-technical

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10 ARNI Approach Airway Level of Concern Satisfactory Worrying Life threatening Breathing Circulation Disability / Dextrose Exposure / Everything else Family

11 Observation Assessment Action Airway Clear Satisfactory Maintain neutral position Breathing RR 70 min -1 Expiratory grunting Reduced AE on left SaO 2 85% ph 7.29 PCO kpa Hypoxic Respiratory acidosis Could be lifethreatening if not addressed Increase inspired oxygen Prepare for respiratory support Circulation HR 150 min -1 MAP 45 mmhg Disability Dextrose Exposure Environment Family BM 3.0 mmol/l Reduced tone, but responsive Temp C No external abnormalities Pregnancy and delivery normal Mother tearful Satisfactory Worrying No additional clues IV access for maintenance fluids & antibiotics No immediate actions Keep family informed Update team on likely next steps

12 Innovative Teaching

13 Innovative teaching - Face Mask Ventilation Real time objective feedback of mask leak during FMV Displayed visually Easy to read colour coded graphics pressure, flow and volume Display of calculated mask leakage

14 Innovative teaching - Face Mask Ventilation Structured teaching package Opportunity to practice informed by biofeedback Different masks Term & Preterm Underpinned by research

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17 Innovative teaching Advanced Airway Skills Video laryngoscope footage Difficult airway algorithm Difficult airway box i-gel Laryngeal masks Airtraqs Seward laryngoscope blade Bougie Reinforced by difficult airway simulation Emphasis on airway safety not intubation at any cost

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19 Communication Workshop 3 scenarios involving antenatal counselling for extreme prematurity Demo scenario - NEC Scenario 1-25 weeks Scenario 2-23 weeks

20 Communication Faculty demo Parents Care Providers Facilitator Debriefer Scenario 1 Parents Care Providers Facilitator Debriefer Scenario 2 Parents Care Providers Facilitator Debriefer

21 Communication Workshop

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23 Continuously assessed simulations All simulations have structured instructor notes including: Learning outcomes Key treatment points Potential discussion points Covers common neonatal emergencies Labour ward NNU Range of pathologies Term & Preterm 40 minutes per simulation Scenario Communication Debrief

24 Post Natal Collapse Covers unsuccessful resuscitation & breaking news of the death of the baby Technical Non-Technical Resuscitation Decision to stop Breaking news to parents

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27 Assessment Need to pass technical and non-technical elements Focus on human factors and communication New continuous assessment tools Summative assessment for airway skill stations Individual feedback on FMV technique Deeper feedback from simulations

28 3 Outcomes Pass: ARNI Provider for 4 years Fail: Certificate of attendance IP: Nominated as having ARNI instructor potential

29 Independent Evaluation mixed methods study pre & post course questionnaires followed by semi-structured interviews Two ARNI courses 32 attendees, 30 completed Q (15 doctors, 13 nurses) - 9 interviews Brown J.M., Mitchell T.K., Kirkcaldy A.J., Shaw B.N.J. Assessing the impact of the Advanced Resuscitation of the Newborn Infant course. Infant 2017; 13(3): Note published correction to original article

30 Improved Confidence for Doctors & Nurses Technical Both Non-Technical FMV Intubation Difficult airway Chest drain insertion Unsuccessful resuscitation Lead Resus Participate in Resus Airway obstruction Pneumothorax CDH NEC Congenital Cyanotic Heart disease Communicate with team during resus Communicate with parents during resus Communicate with parents after resus All significant for Doctors or Nurses at p<0.05 or better

31 I think we all learned the importance of speaking up if there s an issue, effective teamwork and if you think something s being missed, it s okay to say that. Quotes I feel stronger in leading a team also with the right phrases and being able to pick up on cues. It s the fact that procedures are done slicker or without as many problems. The team feel better. It s a lot calmer, therefore there must be some positives for the patient also. You get to where you need to be quicker. As the Consultant... you are expected to lead. But obviously you are expected to do tasks as well and I think that s the one thing I learnt in the ARNI... that when you are task oriented you lose a helicopter view of the overall picture. The session where the baby dies was so emotional, but so important. I feel better prepared if that happens for real I had a resuscitation just the day after ARNI and... because some of those who were with me on ARNI, we said let s do this ARNI style and we did it just like that, but although a very serious resuscitation, because we were all likeminded, thinking very similar and the established roles everybody had a role to perform and we all kept checking with each other, communicating with one another.

32 Challenges Centre investment Faculty heavy Written feedback Access to courses - nurses Roll out New simulations

33 Thanks Working group members Jonathan Wyllie, Joe Fawke, Charlotte Bennett, Jonathan Cusack, John Madar, Lydia Tyszczuk, Louise Anthony, Cassie Lawn, Jenny Ziprin, Ruth Gottstein, Clare Morfoot, Ita Kelly, Vivienne Van Someren, Clare Cane, Rob Bradbury, Kevin Mackie, Zoe Chivers, Fiona Wood With thanks to: Bliss, RCUK, Prof. Ben Shaw

34 Thank-you