Presented at the Neonatal Society 2017 Autumn Meeting (programme).
Lewis P, Taylor A, Nugent M, Montague J, Cantarella A, Mitra S
Neonatal Unit, University College London Hospital, London
Background: Resuscitation and and stabilisation of preterm and sick term babies is a complex process and involves members from several multidisciplinary teams. Attempts to improve the early care of newborn needs to aim to reduce risk and improve safety at each step during this process. A Surgical Safety Checklist published by WHO, has shown to decrease surgical inpatient complications and deaths. We present here a novel Neonatal Delivery Safety Checklist, designed to improve the early thermal care in these group of babies by highlighting its importance at different stages during this process and the importance of multi-disciplinary team communication.
Methods: We process mapped the stages involved in a neonatologist’s attendance at a delivery. This formed the basis of the pilot project where, as in the WHO Surgical Safety Checklist, we identified three ‘vital phases’ a preparatory period where the delivery room temperature can be increased and thermal care kit prepared, immediately before delivery, a pause period where the whole team is encouraged to ask the question “are we ready”, and before transfer to the neonatal unit with a reminder to check the temperature at 15 minutes and act on the result.
Results: The pilot project was rolled out and a rapid response, plan, do, study, act cycle of improvement was initiated. The check list is continuously being modified depending on the feedback and is currently on Version 7 (Fig 1) after three months of use. The admission temperature in babies born at <32 weeks below 36.5ºC during 2 months prior to the introduction of the checklist was 37.5% (May 17) and 50% (June17). The checklist was introduced into clinical practice in June 2017 and revealed a clear improvement in the admission temperature in the following months – 40% (July 17), 33.33% (Aug 17) and 12.5% (Sept 17). Improvement in staff satisfaction with the quality of communication at deliveries has been verbally reported although this requires a formal qualitative assessment.
Conclusion: The Neonatal Delivery Safety Checklist has improved the early care for the vulnerable preterm neonates and consequently has improved admission temperatures.
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1. Haynes A et al. for the Safe Surgery Saves Lives Study Group, N Engl J Med 2009; 360:491-49