Impact of standardized communication techniques on errors during simulated neonatal resuscitation...
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Impact of standardized communication techniques on errors during simulated neonatal resuscitation Nicole K. Yamada, MD, FAAP Senior Fellow, Neonatal-Perinatal Medicine Division of Neonatal and Developmental Medicine October 10, 2014
Impact of standardized communication techniques on errors during simulated neonatal resuscitation Nicole K. Yamada, MD, FAAP Senior Fellow, Neonatal-Perinatal
Impact of standardized communication techniques on errors
during simulated neonatal resuscitation Nicole K. Yamada, MD, FAAP
Senior Fellow, Neonatal-Perinatal Medicine Division of Neonatal and
Developmental Medicine October 10, 2014
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2 In the past 12 months, I have no relevant financial
relationships with the manufacturer(s) of any commercial product(s)
and/or provider(s) of commercial services discussed in this CME
activity. I do not intend to discuss an unapproved/investigative
use of a commercial product/device in my presentation.
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TRACON: Cactus 1529 turn left heading two-seven-zero. Pilot:
This is Cactus 1539 hit birds. We lost thrust in both engines. Were
turning back towards La Guardia. TRACON: Ok yeah, you need to
return to La Guardia. Turn left heading of two-two-zero. Pilot:
Two-two-zero. TRACON: Tower, stop your departures. We got an
emergency returning. Tower: Who is it? TRACON: Its 1529.
He...uhbird strike. He lost all engines. He lost the thrust in the
engines. He is returning immediately. Tower: Cactus 1529 which
engines? TRACON: He lost thrust in both engines he said. Tower: Got
it. TRACON: Cactus 1529 if we can get it for you, do you want to
try to land runway one-three? Pilot: Were unable; we may end up in
the Hudson. TRACON: Alright Cactus 1529 its going to be left
traffic to runway three-one. Pilot: Unable. TRACON: Okay what do
you need to land?
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RN: Stim! Stim! Stim! MD places a floppy, cyanotic baby on the
radiant warmer. MD and RN warm, dry, and stimulate. RN auscultates
for HR while reaching for PPV mask. MD: [to father] Hello.
Congratulations. RN: Hold on, I cant hear [the HR while baby is
being dried]. Stop stop. MD stops drying. RN: Its slow. [RN begins
PPV with pop-off valve alarming, inadequate filling volume of bag,
and inappropriately fast RR.] Keep stim-ing. RN: [to baby] Whats
going on? Huh? MD: [auscultates HR] I think we need to intubate.
RN: Yeah, go ahead. Why dont you get that bag while I get the
[intubation] tray. MD: [MD takes over PPV, and continues improper
technique] Can you call for an extra hand from the NICU please? MD:
[to RN] I cant get it, can you do it? RN: Yeah, ok. Neonatal
Resuscitation RN takes over PPV, and MD steps away to get
intubation supplies.
Slide 7
MD: Did you guys hear me? Can you guys call the NICU? Because
we need an extra hand. OB RN: Call the team? What do you want? Who
do you want? WHO DO YOU WANT? RN: WHO DO YOU WANT? MD: Um, anybody.
Uh. One of the doctors. Get one of the doctors. OB anesthesiologist
is at the bedside and listens to the babys heart rate, then puts
down the stethoscope and walks around to other side of bed. OB RN:
[on phone with NICU] Hi can we get one of the doctors in OR A
please. [hangs up] RN alternates between providing inadequate PPV
and rubbing the babys back. RN: Okay, come on. You feeling better?
[baby begins cries weakly] There you go. OB RN: You want the tray?
RN: Yeah, shes getting it. [Continues inadequate PPV for 5 breaths,
then stops to pick up the stethoscope.] We need to keep listening
to her. RN: Shes got a great heart rate. She just doesnt want to
breathe. MD: She does have a good heart rate? OB anesthesiologist:
Yeah. It was very good. Very strong. Neonatal Resuscitation
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12 HR > 100 bpmImplies no PPV (or stop PPV) HR 60 bpm)PPV
indicated HR < 60 bpmImplies start CC after 30 sec of effective
PPV HR zero (or undetectable)Influences length of
resuscitation
Slide 13
13 When breath sounds present: Breath sounds present left
Breath sounds present right Breath sounds present bilaterally When
breath sounds decreased: Breath sounds decreased left Breath sounds
decreased right Breath sounds decreased bilaterally When breath
sounds absent: Breath sounds absent left Breath sounds absent right
Breath sounds absent bilaterally
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15 Non-Standard Communication Mean (SD) Resuscitation Lexicon
Mean (SD) P-value Average error rate0.40 (0.07)0.37 (0.08)0.18
Errors of omission0.32 (0.06)0.28 (0.08)0.09 Errors of
commission0.08 (0.04)0.09 (0.04)0.28
Slide 16
16 Non-Standard Communication Mean (SD) Resuscitation Lexicon
Mean (SD) P-value Average number of communication techniques used
6.7 (2.5)15.5 (5.0)0.0015* Time to initiation of PPV32.4 sec (16.9
sec)30.7 sec (15.4 sec)0.58 Time to initiation of CC120.7 sec (66.8
sec)112.8 sec (70.8 sec)0.78