P3.R343: Neonatal Roadshow: Designing and Implementing Practice Changes of Neonatal Resuscitation Program (NRP®) at the Community Hospital Level by Regional Perinatal Center

Purpose/Objectives: Effective resuscitation using the Neonatal Resuscitation Program® (NRP®) can reduce morbidity and mortality. Since the onset of perinatal regionalization to designated levels of neonatal care, higher level care is associated with improved outcomes. Outreach programs provided by regional perinatal center’s (RPCs) improve patient outcomes and can help identify latent safety threats (LSTs). Our perinatal outreach visits in Northeastern New York (NE NY) with our regional community hospitals reported gaps in implementing practice changes recommended in the NRP® 7th Edition. Community hospitals perform neonatal resuscitation at a relatively low frequency allowing for opportunities for LSTs. The increased number of transports to NE NY RPC prompted an exploratory analysis. As the RPC, qualitative interviews were conducted at onsite visits with the resuscitation teams. Descriptive analysis of data trends was reviewed and identified a decline in neonatal resuscitation competency over the years with NRP® edition evolutions. Our hypothesis is procedural educational sessions with simulation onsite in community hospitals will improve the quality of neonatal resuscitation in participating hospitals which should improve outcomes for newborns as well as optimize the use of limited transport resources from the RPC.

Design/Methods: We designed a formalized educational curriculum that includes scenario development with targeted objectives using simulation for providers based on NRP® standards. A 10-question anonymous pre- and post-questionnaire to assess NRP® competencies and confidence with performance were distributed to each multidisciplinary team before and after the educational session. We have hosted two on-site educational sessions with simulation with scheduled quarterly for the next year.

Results: An analysis of anonymous pre- and post-questionnaire of NRP® competencies and confidence with performance was completed looking for improvement in all domains. Our findings included statistically significant improvements in confidence in effectively providing ventilation; initial steps of care; rapid evaluation of the newborn; and using the 4 pre-birth questions to assist in risk identification. Additional findings (and areas of opportunity) included: proper sequence of initial steps; recommended timing of EKG lead placement; and reasonable timeframe for considering cessation of resuscitation efforts. Due to time constraints to adequately cover the material during site visits, questions involving medications were excluded.

Conclusion/Discussion: There has been an increased percentage of neonates greater than 35 weeks with low APGAR scores requiring assisted ventilation immediately after birth in the NE NY region. These findings may indicate poorly executed neonatal resuscitation immediately after birth and coincide with community hospitals struggling to stay current with new editions of NRP®. The foundation of NRP® is that regardless of equipment or location, community hospitals and RPCs should maintain the same high-quality standard of NRP® with interval educational sessions to maintain competency. Through our multidisciplinary, on-site, educational sessions with simulation, we found improvement in competency and confidence in the current standard of resuscitation of newborns.