The birth of a newborn is generally a smooth and uncomplicated experience for the labor and delivery staff. However, being prepared for any unexpected complication is necessary. Nearly 10% of newborns will require some level of assistance after birth, such as clearing of the airway or support with breathing and circulation.1
A coordinated and interdisciplinary team should always be ready to confidently and swiftly respond to any complications during delivery. This will support the newborn to have the smoothest possible transition.
One priority for staff attending a birth is preparation, with all equipment ready to support transition and stabilization. Even if your team members feel ready for the most complex birth, here are a few ways your staff can always be prepared for all deliveries.
Ongoing Staff Training
By providing team members a chance to participate in simulations and mock codes, you can help alleviate some anxiety and encourage better outcomes.2 Simulations also give leadership the opportunity to review unit protocols in real-time to ensure that everyone is clear on defined roles and current procedures.3 Potential team errors can also lessen when team members are given a safe learning environment to practice in while receiving constructive feedback. Additionally, debriefing the team both before and after the exercise can help everyone identify potential weak spots in their own workflow and where they can step up.
When planning simulations and staff education, leadership should consider that the characteristics of high-performing teams include the following:
- Established, defined roles
- Self-awareness of skills
- Space to provide real-time feedback
- Verbal updates and summarization of actions, coupled with repeating and verifying information
- Direct, clear communication
- Professional, courteous attitude during stressful situations
Technology and Equipment
In addition to simulations, effective intervention focuses on technology and equipment, and incorporating them into your team workflow. This includes positioning all necessary equipment at the bedside or in the delivery room, ensuring all equipment is functioning, and having a code cart nearby and fully stocked with appropriate supplies and medications for every delivery.
A list of supplies creates a standardized guide that clinical staff can refer to when it comes time to re-stock. Some of the necessary equipment and supplies to have available for every delivery include the following:
- Preheated infant radiant warmer with integrated suction, flowmeter, oxygen blender and cylinder tank holders for transport
- Warm towels
- SpO2, temperature, ECG monitor and patient probes (preferably integrated in the radiant warmer)
- Hat
- Plastic wrap/bag
- Thermal mattress
- Bulb syringe and suction catheter
- Stethoscope
- T-piece or bag and mask
- Intubation and medication supplies
Unit leaders should purchase supplies and equipment that are intuitive, with easy-to-use features. The right tools help simplify the workflow for the interdisciplinary team. Consider equipment with integrated features to help consolidate and increase efficacies in equipment management.
Staff Readiness
The current best practice is to have at least one highly skilled person in neonatal resuscitation always nearby and ready to respond during deliveries. Keen assessment skills and the ability to intervene and remain calm are some of the characteristics needed to facilitate effective resuscitation. Although it is important to have that resuscitation specialist nearby, all nurses and clinical staff on the delivery team responsible for the care of the mother and baby should be trained, prepared, and ready to act quickly in emergency situations.
All staff should be trained on neonatal resuscitation essentials—and neonatal resuscitation advanced skills should be required for health care providers who perform care beyond positive pressure ventilation.
The resuscitation process should follow a structured algorithm. The team should be familiar with the details concerning preparation, rapid evaluation, airway management, breathing, circulation, and medications. Additionally, some of the key behavioral skills that teams should practice include
- Ability to identify a team leader and manager their workload
- Effective communication and preparation skills (but will ask for help when needed)
- Efficient use of available resources
- Professional behavior
Neonatal team members should quickly huddle before deliveries so they can define roles prior to a possible intervention. This allows for more time on providing effective support for transition, including life-saving measures over ineffective, in-the-moment communication.
Room to Grow
Preferably every three to twelve months, clinical staff should be involved in simulations, mock codes, and training sessions for continued learning and development. Teams and individual clinicians should also regularly work to communicate effectively, define (or redefine) their roles and responsibilities, and become familiar with the latest in neonatal resuscitation recommendations, clinical standards and technology.
Whether or not there are areas to easily improve your team's workflow, leaders and managers should strive to increase the effectiveness of their current procedures. There is always room to grow.
References:
- Aziz K, Lee HC, Escobedo MB, et al. Part 5: Neonatal resuscitation 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Pediatrics. January 2021;147 (Supplement 1): e2020038505E. https://doi.org/10.1542/peds.2020-038505E
- Hazwani TR, Alosaimi A, Almutairi M, et al. The impact of mock code simulation on the resuscitation practice and patient outcome for children with cardiopulmonary arrest. The Cureus Journal of Medical Science. July 2020;12(7): e9197. doi: 10.7759/cureus.9197
- Calder LA, Mastoras G, Rahimpour M, et al. Team communication patterns in emergency resuscitations: a mixed methods qualitative analysis. The International Journal of Emergency Medicine. July 2017;10:24. doi: 10.1186/s12245-017-0149-4
