G99(P) Resuscitating resus:

Abstract

Aims Critically sick children need to receive appropriate resuscitation as swiftly as possible. The Resuscitation Council state ‘Staff (should) have immediate access to appropriate resuscitation equipment and drugs’ with a ‘reliable system of equipment checks and replacement’. Clinical incident reporting and weekly simulation training identified latent environmental errors in the paediatric resuscitation bay in the emergency department of busy district general hospital. Our aim was to identify reasons for this and areas for improvement. Methods This was an observational study of time taken for trainees to find emergency equipment. Two lists were devised of simple airway and intravenous access and fluid bolus equipment. We timed one trainee finding specific equipment in our current resuscitation bay, identifying improvement areas using trainee and observer feedback. After a multi-disciplinary departmental meeting to consolidate opinion, an action plan was devised. We then redesigned the bay and retimed a trainee finding the same equipment. The changes involved creating three uniform circulation trolleys of paediatric cannulation and fluid bolus equipment. Labels were placed below each piece of equipment and photographic checklists created. The same principles were used for the airway trolley. Results Prior to the changes, Trainee 1 took a protracted amount of time to find a paediatric non-rebreath mask and during the circulation speed test, could only find half a culture kit after searching multiple trolleys and used the last bag of 10% dextrose in the paediatric bay. After our changes, Trainee 2 found all airway adjuncts in the airway trolley and only required one grab trolley to successfully collate all circulation equipment with a decrease in time. Conclusions Although two different trainees were used, both were similar grades with a similar amount exposure to the resuscitation bay. We showed with no money or extra resources you can ensure a safer environment for patients by ensuring uniformity and clear labelling. Staff reported finding the area easier to navigate, more intuitive and clearer to restock.