The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

A NEONATAL RESUSCITATION PROGRAM (NRP) SIMULATION QUALITY IMPROVEMENT STUDY.

Daniel D. Woodhead1, Robert D. Christensen1



Background: In 1987 NRP was released as a means of improving resuscitation skills for professionals attending to neonates at delivery. The current course outline contains nine lessons ranging from principles, skills, and steps of positive pressure ventilation, chest compressions, intubation, medications, special considerations, and ethics. Once learned, a competency test is completed and principles and skills evaluated. The IOM and Joint Commission have encouraged NRP simulation-based training. A NRP simulation program was introduced in the northern region of Intermountain Healthcare in August of 2007. The present study was undertaken to evaluate performance of NRP simulation classes, specifically evaluating five key NRP skill-sets. We speculated that if specific skill-sets could be identified where performance was poor, additional education and training could subsequently be focused on strengthening those weak areas.

Methods:
Seventy-seven professionals, including respiratory therapists (n=14), NICU nurses (n=41), L&D nurses (n=12), NICU nurse practitioners (n=1), neonatalogists (n=1), and third year Family Medicine Residents (n=8), were enrolled into the NRP simulation classes. Information was collected by a single observer (DDW) on whether each of five skills-sets was performed properly. Simulation was accomplished by 64 separate teams of professionals. Fisher Exact was used to compare the performance of each skill-set with the performance of all other skill-sets. The study was approved by the Intermountain Healthcare IRB.

Results:
The numbers shown in the table are percent and actual number (in parentheses) of their skill-sets performed properly, according to the 2007 NRP manual.

Conclusions:
Suctioning of the mouth and nose was the skill-set most often performed improperly during NPR simulation, with only about ½ of the teams performing this skill correctly. We speculate that this specific area of NRP training should be further emphasized in the NRP courses, in order to avoid a weakness in this important aspect of neonatal resuscitation performance.