G413(P) Intubation in the neonatal unit- improving our performance and fostering human factor awareness

Abstract

Background There are instances when neonates require endotracheal intubation for treatment or investigations, successful neonatal intubation requires a series of complex technical skills. There can be an added difficulty in elective intubation where human factors come into play, potentially more so than with an emergency. Prior to intubating a neonate, trainees said they felt nervous, anxious and stressed amongst other emotions. Aim To increase the rate of successful 1 st attempt simulated neonatal intubations performed by Paediatric staff by 50% by May 2018. Successful intubation defined as endotracheal tube placed in the correct position and within 60 s. To reduce the time taken to successful intubation. To improve awareness of the impact of human factors on technical skills such as neonatal intubation. Methods Introduction of a neonatal simulation based teaching programme consisting of 4 workshops: Preparing, prescribing and administering drugs for intubation Intubation Ventilation Human factors Process change: PDSA 1: Workshops planned, invites sent and first cohort attended. PDSA 2: Challenges and problems addressed. This included moving to the neonatal unit where a gas supply was available. There was wider discussion on indications for intubation and mechanical ventilation. PDSA 3: Workshops established into the local teaching programme. Results 47% reduction in average time taken to successful intubation. 88% intubations successful on first attempt post teaching. Improved trainee self rated competence and confidence in all aspects of neonatal intubation between PDSA 1 and PDSA 2. Improved recognition and ability to appreciate the impact of human factors. Conclusions The power of human factors dialogue breaks down hierarchy, barriers and promotes morale and team working. Workshop on identification of human factors, their impact and how to manage these promoted individual and team awareness of human factors. We demonstrated improved competence and confidence in all aspects of neonatal intubation and a reduction in the time taken to successful simulated intubation. The positive impact of the workshops on trainees has led to us establishing this teaching formally into the local paediatric teaching programme.