Neonatal Resuscitation I N S T R U C T O R M A N U A L From Zaichkin, NRP Instructor Jeanette;Weiner, Manual: Gary;Major,, Cheryl From Zaichkin, Downloaded NRP Jeanette;Weiner, Instructor on May Manual: 15, 2018, Gary;Major,, 6:01 AM Cheryl at 148.251.232.83 Zaichkin, Downloaded Published Jeanette;Weiner, by on AAP, May 2011. 15, 2018, Gary;Major, All rights 6:01 AM reserved. Cheryl at 148.251.232.83 Downloaded Published by on AAP, May 2011. 15, 2018, All rights 6:01 reserved. AM at 148.251.232.83
Supported in part by
Instructor Manual for Neonatal Resuscitation Editor Jeanette Zaichkin, RN, MN, NNP-BC Associate Editors Gary Weiner, MD, FAAP Cheryl Major, RNC-NIC, BSN NRP Steering Committee Members Christopher Colby, MD, FAAP Marilyn Escobedo, MD, FAAP Karen D. Fairchild, MD, FAAP Louis P. Halamek, MD, FAAP George A. Little, MD, FAAP Jane E. McGowan, MD, FAAP Steven Ringer, MD, PhD, FAAP Gary M. Weiner, MD, FAAP Myra H. Wyckoff, MD, FAAP NRP Steering Committee Liaison Representatives Praveen Kumar, MD, FAAP AAP Committee on Fetus and Newborn Mildred Ramirez, MD, FACOG American College of Obstetricians and Gynecologists Khalid Aziz, MD, FRCPC Canadian Paediatric Society Barbara Nightengale, RN, MSN, NNP-BC National Association of Neonatal Nurses John Gallagher, RRT-NPS American Association for Respiratory Care Managing Editor Rachel Poulin, MPH Wendy Marie Simon, MA, CAE The committee would like to express thanks to the following reviewers and contributors: Susan Amundsen Jodee Anderson, MD, FAAP Julie Arafeh, RN, MSN Denise Dubuque, RN Leslee Goetz, MN, RNC-OB Cynthia Jensen, RN, MS, CNS Sarah A. Korkowski, MSN, NNP-BC Terrie Lockridge, MSN, RNC-NIC Lori A. Markham, MSN, MBA, NNP-BC, CCRN Linda McCarney, MSN, RN, NNP-BC, EMT-P Karen Menghini, RN, MSN, NNP-BC Kathy O Connell, MN, RN Webra Price-Douglas, PhD, CRNP, IBCLC Brian K. Ross, PhD, MD Frances E. Rushton, MD, FAAP, AAP Board-appointed Reviewer Sharyl Sadowski, MS, RNC, AP, NNP-BC Theodora (Lola) Stavroudis, MD, FAAP Laura A. Stokowski, MS, RN Lauren Thorngate, PhC, RN, CCRN Kim Watkins, RRT-NPS AAP Life Support Staff Wendy Marie Simon, MA, CAE Rory Hand, EdM Rachel Poulin, MPH Kristy Crilly Nancy Gardner Melissa Marx AAP Marketing and Production Staff Theresa Wiener Copyeditor Jill Rubino American Heart Association Emergency Cardiovascular Care Leadership Leon Chameides, MD, FAAP Brian Eigel, PhD Mary Fran Hazinski, RNC Robert Hickey, MD, FAAP Vinay Nadkarni, MD, FAAP American Heart Association Emergency Cardiovascular Care Pediatric Subcommittee Marc D. Berg, MD, FAAP, Chair, 2009-2011 Monica E. Kleinman, MD, FAAP, Immediate Past Chair, 2007-2009 Dianne L. Atkins, MD, FAAP Jeffrey M. Berman, MD Kathleen Brown, MD, FAAP Adam Cheng, MD Laura Conley, BS, RRT, RCP, NPS Allan R. de Caen, MD Aaron Donoghue, MD, FAAP, MSCE Melinda L. Fiedor Hamilton, MD, MSc Ericka L. Fink, MD, FAAP NRP TM Eugene B. Freid, MD, FAAP Cheryl K. Gooden, MD, FAAP John Gosford, BS, EMT-P Patricia Howard Kelly Kadlec, MD, FAAP Sharon E. Mace, MD, FAAP Bradley S. Marino, MD, FAAP, MPP, MSCE Reylon Meeks, RN, BSN, MS, MSN, EMT, PhD Vinay Nadkarni, MD, FAAP Jeffrey M. Perlman, MB, ChB, FAAP Lester Proctor, MD, FAAP Faiqa A. Qureshi, MD, FAAP Kennith Hans Sartorelli, MD, FAAP Wendy M. Simon, MA, CAE Mark A. Terry, MPA, NREMT-P Alexis Topjian, MD, FAAP Elise W. van der Jagt, MD, FAAP, MPH Arno Zaritsky, MD, FAAP Associated Education Materials for the Instructor Manual for Neonatal Resuscitation, 6 th Edition Textbook of Neonatal Resuscitation, 6th Edition, John Kattwinkel, MD, FAAP, Editor; Jane McGowan, MD, FAAP, and Jeanette Zaichkin, RN, MN, NNP-BC, Associate Editors NRP Instructor DVD: An Interactive Tool for Facilitation of Simulation-based Learning, Louis P. Halamek, MD, FAAP, and Jeanette Zaichkin, RN, MN, NNP-BC, Editors NRP Online Examination, Steven Ringer, MD, PhD, FAAP, and Jerry Short, PhD, Editors NRP Reference Chart, Code Cart Cards, and Pocket Cards, Karen D. Fairchild, MD, FAAP, Editor NRP Simulation Poster, Louis P. Halamek, MD, FAAP, Editor Simply NRP, Gary Weiner, MD, FAAP, and Jeanette Zaichkin, RN, MN, NNP-BC, Editors Neonatal Resuscitation Scenarios, Gary Weiner, MD, FAAP, and Jeanette Zaichkin, RN, MN, NNP-BC, Editors
Fifth edition, 2011 Fourth edition, 2006 Third edition, 2000 Second edition, 1995 First edition, 1987 ISBN-13: 978-1-58110-501-8 NRP303 All rights reserved. Printed in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of the material protected by this copyright notice may be reproduced or utilized in any form, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner. The material is made available as part of the professional education programs of the American Academy of Pediatrics and the American Heart Association. No endorsement of any product or service should be inferred or is intended. The Academy has made every effort to ensure that contributors to the Neonatal Resuscitation Program materials are knowledgeable authorities in their fields. Readers are nevertheless advised that the statements and opinions expressed are provided as guidelines and should not be construed as official policy of the American Academy of Pediatrics or the American Heart Association. The recommendations in this publication or the accompanying materials do not indicate an exclusive course of treatment. Variations, taking into account individual circumstances, nature of medical oversight, and local protocols, may be appropriate. The American Academy of Pediatrics and the American Heart Association disclaim any liability or responsibility for the consequences of any actions taken in reliance on these statements or opinions. The American Academy of Pediatrics reserves the right to disclose personal information of course participants/ providers for administrative purposes such as to verify participation or classes taken or to validate the status of any course completion card. In no event shall the American Academy of Pediatrics or the publisher have any liability for disclosure or use of information for such purposes or responsibility for the consequences of any actions taken in reliance on such information. Copyright 2011 by American Academy of Pediatrics and American Heart Association 1 2 3 4 5 6 7 8 9 10
Contents Foreword NRP TM CHAPTER 1: Neonatal Resuscitation Program TM : Past, Present, and Future... 1 CHAPTER 2: Core Elements and Course Requirements... 15 CHAPTER 3: Course Planning: Who Learns What, and How?... 29 CHAPTER 4: The Online Examination... 51 CHAPTER 5: Organizing Supplies and Arranging the Classroom... 63 CHAPTER 6: Administering Performance Skills Stations... 83 CHAPTER 7: Simulation... 97 CHAPTER 8: Debriefing... 127 CHAPTER 9: Instructor Courses... 143 CHAPTER 10: Course Documentation... 173 iii
Contents APPENDIX A: Neonatal Resuscitation Program TM Instructor Self-assessment... 187 Answer Sheets for Chapters 2 Through 10 188 Questions for Chapters 2 Through 10 191 Answers for Chapters 2 Through 10 199 APPENDIX B: Roster Samples... 207 Completed Course Roster Sample 208 Neonatal Resuscitation Program Course Roster Sample 209 Information Needed to Complete the Instructor Course Roster 210 APPENDIX C: Planning a Course... 187 APPENDIX D: Basic Equipment and Supplies Needed for Most Neonatal Resuscitation Program Courses 212 Experience Survey 214 Create a Medication Performance Skills Station 216 Make a Medication Performance Skills Station Doll 218 How to Prepare Umbilical Cords for Skills Stations 221 Sample Timeline and Details for a Neonatal Resuscitation Program Provider Course 222 Sample Projected Budget Worksheet 238 Neonatal Resuscitation Program TM Provider Course... 239 Registration Confirmation: Sample Letter 240 Course Agenda: Sample 1 242 Course Agenda: Sample 2 243 Diagram for Neonatal Resuscitation Program Course Setup: Sample 244 Provider Course Individual Recording Sheet: Sample 245 Master Recording Sheet 246 Provider Course Evaluation: Sample 1 247 Provider Course Evaluation: Sample 2 248 Neonatal Resuscitation Program Provider Card Mailing: Sample Letter 249 Published i v by AAP, 2011. All rights reserved.
Contents APPENDIX E: Performance Skills Checklists and Textbook Key Points... 251 Equipment Check 252 Initial Steps 256 Positive-Pressure Ventilation 261 Chest Compressions 266 Endotracheal Intubation and Laryngeal Mask Airway Placement 272 Medication Administration via Endotracheal Tube and Emergency Umbilical Venous Catheter 281 Integrated Skills Station Performance Checklist (basic) 288 Integrated Skills Station Performance Checklist (advanced) 290 List of Neonatal Resuscitation Program Resuscitation Skills Videos 292 Key Points: Lessons 1 Through 9 292 APPENDIX F: Scenario and Debriefing Tools... 305 Neonatal Resuscitation Program Key Behavioral Skills 306 NRP Key Behavioral Skills in Action 307 Ground Rules for Simulation and Debriefing: Sample 308 CAPE Confidentiality Agreement: Sample 309 Scenario Template (blank and completed) 310 Instructions for Using the Sample Scenario Template 314 Scenario Building Tool 316 Simulation Preparation, Tips, and Sample Debriefing Questions 319 CAPE Debriefing Evaluation Tool and Instructions for Use 320 Ready, Set, Go: Neonatal Resuscitation Program Instructor Prep Sheet for Simulation and Debriefing 322 NRP Instructor Simulation and Debriefing Checklist 323 The Art of Moulage: Guidelines, Recipes, and Easy Techniques 325 v
Contents Guidelines for Using Moulage 325 Recipes for Blood, Vernix, Meconium 328 Acrocyanosis 328 Abdominal Defect 329 Chest Glow With Transillumination 330 Make a Pulse Oximeter Out of a Box 330 Make a Pulse Oximeter From a Desktop Card File 332 The Neonatal Mock Code 332 APPENDIX G: Instructor Courses... 337 Hospital-based Instructor Course Hospital-based Instructor Course Sample Curriculum 338 Sample Letter: Eligibility Confirmation 341 Sample: Letter of support from applicant s manager/ supervisor/hospital administrator 342 Sample Letter: Registration Confirmation in Instructor Course 343 Hospital-based Instructor Course: Sample Individual Recording Sheet 344 Sample Letter: Neonatal Resuscitation Program Resources 345 Sample Hospital-based Instructor Course Evaluation 346 Regional Trainer Course Registration Confirmation for Regional Trainer Course: Sample Letter 347 Regional Trainer Course: Sample Individual Recording Sheet 348 Sample Regional Trainer Course Evaluation: Sample 349 Managing Challenging Classroom Situations 350 APPENDIX H: Neonatal Code Forms and Documentation... 351 Sample Neonatal Code Forms 352 Sample Narrative Note to Accompany Code Documentation Form 357 Medications for Neonatal Resuscitation 358 How to Administer Dopamine Hydrochloride 359 Published v i by AAP, 2011. All rights reserved.
Contents American College of Obstetricians and Gynecologists/The American Academy of Pediatrics Policy Statement: The Apgar Score 361 American College of Obstetricians and Gynecologists Practice Bulletin: Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles 365 APPENDIX I: Resuscitation Supplies and Equipment... 377 Neonatal Resuscitation Supplies and Equipment 378 Neonatal Resuscitation Program Quick Pre-resuscitation Checklist 380 Organizing Supplies and Equipment 381 vii
Foreword NRP TM Five years ago, the Neonatal Resuscitation Program (NRP) Steering Committee started a serious discussion about the quality of NRP learning. After 20 years, the NRP was due for a change. Our slide and lecture format was lagging behind adult learning theory, and our curriculum did not adequately address teamwork and communication. Neonatal Resuscitation Program instructors were doing such a great job teaching every lesson of the NRP textbook and helping students through their Megacode that students needed to do nothing to prepare. Some students would show up to their NRP course with the textbook still in its plastic wrapper, and NRP veterans did not expect to learn much new. With so many people needing NRP provider status as a requirement of employment or credentialing, we were losing our focus on quality learning and instead, measuring our success by how fast we could get learners through a Megacode check-off. This was efficient and well intentioned, but not in the best interests of our learners or the babies in need of resuscitation. In addition, we knew that not every instructor was committed to NRP excellence, and some participated in a very small way to maintain their instructor status only to avoid any type of evaluation. Just over 2 years ago, in a trial attempt of the proposed 6 th edition course format, I led my first NRP Provider Course using a simulation-based curriculum. I was nervous, and couldn t do every single thing I wanted to do (we didn t film the scenarios), but it was a start. It marked the first time I had asked students to read the textbook and take the online examination before coming to the course. Would they feel resentful about this precourse preparation and feel I was slacking off as their NRP instructor? Would they know the information? Would I end up lecturing lesson-by-lesson anyway? I was surprised when every student handed in their examination verification for the online examination and, when questioned, had no complaints about the process. No one missed the slides and lecture. They just wanted to get to work. I explained the new methodology and confessed that they were my first students of simulation-based learning. They were happy to help with this experiment. Some of my ideas worked, and some were not successful. At this first course, we kind of bumbled through it together, and we learned a lot. We covered the manikin with fake blood and pureed green bean meconium and probably laughed too much during those first scenarios. After the course, 2 of the participants told me it was the best NRP class they had ever taken. It was certainly the best NRP class I had ever experienced. It was scary, it was more work than the old way of teaching, and, at first, it took more time, but it was great fun. Two years later, we re still refining and tweaking the course, but we re pretty good at it now. ix
Foreword And students are still telling us that our courses offer the best learning environment and the most engaging NRP experience they have ever had. We are lucky to be NRP instructors at this moment in NRP development. This is a landmark edition and marks the most significant changes made to the teaching methodology since the inception of the course in 1987. You may need some time to learn the new methods, but it will be worth it in the end because these will be the finest courses you have ever taught. With your skills and guidance, your students will come to you after their course and say, That was the best NRP course ever. If simulation-based learning is new to you, don t feel as though you must be an expert at the beginning. Read and watch the new materials and take the first steps with an open mind and a sense of adventure. As you gain experience, you will find your own style within these concepts, and soon you will appreciate major improvements in team performance. The real payoff will come when a team identifies something during a debriefing that needs improvement and will result in a better outcome for newborns. This is my third edition as editor of the Instructor Manual for Neonatal Resuscitation. More than any previous edition, I needed input from many people to make our manual practical and understandable. My goal is to keep the Neonatal Resuscitation Program useful for all health care professionals in many different birth settings, and I believe our team has accomplished this goal. I especially wish to thank Dr. Gary Weiner for his incredible knowledge of neonatal resuscitation and the best ways to learn it, and for his humor, encouragement, and optimism when things got discouraging. I also wish to thank Dr John Kattwinkel for his patience and leadership as we ensured that the textbook, the Instructor DVD, the Instructor Webinars, Simply NRP, and the Instructor Manual presented consistent information in all formats. Thank you to Dr Louis Halamek who taught me most of what I know about simulation and debriefing. A special thanks to Wendy Marie Simon, Rachel Poulin, and Rory Hand at the American Academy of Pediatrics, who have worked with me on an almost daily basis for the past 2 years to get all these projects pulled together on time and in great shape. I hope you will embrace these changes and enjoy renewed enthusiasm as an NRP instructor. Not only will your students have a chance to grow professionally with each course, so will you. Jeanette Zaichkin, RN, MN, NNP-BC Published x by AAP, 2011. All rights reserved.