The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts

USING SIMNEWB TO DEVELOP A DECISION-MAKING SIMULATION FOR SURFACTANT ADMINISTRATION AND MANAGEMENT OF A 28-WEEK GESTATION INFANT IN RESPIRATORY DISTRESS.

Tammy L. Babcock1, Daneen Nastars1, Paula D. Cowan2, Jose D. Rojas1; 1Department of Respiratory Care - School of Health Professions, University of Texas Medical Branch Galveston, Galveston, TX; 2Department of Respiratory Care, University of Texas Medical Branch Galveston, Galveston, TX

Background: Respiratory care graduates’ decision-making ability is assessed on attempting the clinical simulation exam (CSE) portion of the RRT credential, including one neonatal patient as part of this exam. National first time pass rate for the CSE has hovered around 60%. NBRC results summary describe one of these neonatal patients as a 28-week gestation infant in respiratory distress. Many of our students struggle with decision making on this particular case and 38.7% (n =48) failed this decision-making section. Although one of our primary neonatal clinical affiliates provides excellent learning opportunities with a Level III NICU and over 5000 births per year (approximately 2% are in the 28-32 week gestation range), the instability of neonates and the crowded NICU can preclude direct hands on experience. High fidelity simulators have been used to improve decision-making and hands on training in high acuity neonates. Using these simulators, we have developed simulations that address the management and decision-making for a 28-week gestation infant that requires intubation, surfactant replacement, and mechanical ventilation. Method: We modified Laerdal’s SimNewB such that the Ingmar ASL 5000 controls breathing. Using actual patient cases, we created infants that present in distress and require surfactant replacement. Students participate in the care and management of these infants from delivery room to the NICU, including administration of surfactant and adjustment of ventilator parameters. Results: These scenarios insure that all students are provided with the same NICU experience. We implemented the use of these scenarios with our junior class after their neonatal course and before their NICU rotations that occur in the Spring. Students will be tested with these scenarios at three different time points in the Fall semester before they attempt the CSE. Conclusion: We hypothesize that use of these scenarios will improve decision-making ability. Outcome measures used to assess improvement will be performance on the developed scenarios and the students’ decision-making scores on the CSE neonatal patient. Our students (n = 48; 6 cohorts) have averaged a score of 10.6 +/- 3.14 on decision making of the 28-wk gestation CSE (minimum passing score =11). We anticipate that introduction of this specific activity will improve their performance and decision-making scores. Sponsored Research - None