Telemedicine for Neonatal Resuscitation

Abstract

Poster Presentation Purpose for the Program Maintaining high levels of readiness for neonatal resuscitation in settings with low‐risk maternity services is challenging. Use of the American Academy of Pediatrics Neonatal Resuscitation Program (NRP) algorithm is a community standard in the United States; however, training is often only required every 2 years, and few staff receive enough exposure to these critical events to be proficient at timely implementation of the algorithm and advanced procedures such as umbilical vein access and endotracheal intubation. Birth centers may not have a practitioner immediately available to lead neonatal resuscitation. Even when staff is trained in advanced procedures, the skills needed for full resuscitation are not performed regularly, and low levels of comfort with these skills are reported. Additionally, task saturation occurs when team leaders are expected to perform advanced procedures while leading the resuscitation team. There are reports that errors in neonatal resuscitation continue to occur related to team skill level, including problems with effective training, muscle memory building, communication, and task saturation. At sites where there is limited exposure to emergency events because of low volumes of high‐risk deliveries, staff may never build up the experience needed to efficiently and effectively resuscitate a premature or ill newborn. Proposed Change To develop a Telemedicine Resuscitation Program that links a remote NRP leader in an neonatal intensive care unit (NICU) to low‐risk maternity centers. There is evidence to support the value of hands‐free leadership to help prevent task saturation and the benefits of communication to promote patient safety. Implementation, Outcomes, and Evaluation We implemented the program between a Level‐ IV NICU and three Level‐I nursery sites within our system. Every patient event was tracked, debriefed, and analyzed. Our outcomes data show an improvement in team support and improved communication, which have led to more effective, consistent adherence to NRP principles and a positive effect on time‐to‐transfer initiation and time‐to‐initiation of neuroprotective cooling. Implications for Nursing Practice This novel use of telemedicine for remote neonatal resuscitation leadership could support perinatal teams at community hospitals by tertiary care centers. Furthermore, it could improve medical care in remote and low‐resource birthing centers throughout the United States and around the world.