Impact of a novel decision support tool on adherence to Neonatal Resuscitation Program algorithm

Janene H Fuerch; Nicole K Yamada; Peter R Coelho; Henry C Lee; Louis P Halamek

doi:10.1016/j.resuscitation.2014.12.016

Impact of a novel decision support tool on adherence to Neonatal Resuscitation Program algorithm

Resuscitation. 2015 Mar:88:52-6. doi: 10.1016/j.resuscitation.2014.12.016. Epub 2014 Dec 30.

Authors

Janene H Fuerch¹, Nicole K Yamada², Peter R Coelho³, Henry C Lee², Louis P Halamek²

Affiliations

¹ Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, United States. Electronic address: jfuerch@stanford.edu.
² Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, United States.
³ MedicalCue(®), Mountain View, CA, United States.

PMID: 25555358
DOI: 10.1016/j.resuscitation.2014.12.016

Abstract

Aim: Studies have shown that healthcare professionals (HCPs) display a 16-55% error rate in adherence to the Neonatal Resuscitation Program (NRP) algorithm. The aim of this study was to evaluate adherence to the Neonatal Resuscitation Program algorithm by subjects working from memory as compared to subjects using a decision support tool that provides auditory and visual prompts to guide implementation of the Neonatal Resuscitation Program algorithm during simulated neonatal resuscitation.

Methods: Healthcare professionals (physicians, nurse practitioners, obstetrical/neonatal nurses) with a current NRP card were randomized to the control or intervention group and performed three simulated neonatal resuscitations. The scenarios were evaluated for the initiation and cessation of positive pressure ventilation (PPV) and chest compressions (CC), as well as the frequency of FiO2 adjustment. The Wilcoxon rank sum test was used to compare a score measuring the adherence of the control and intervention groups to the Neonatal Resuscitation Program algorithm.

Results: Sixty-five healthcare professionals were recruited and randomized to the control or intervention group. Positive pressure ventilation was performed correctly 55-80% of the time in the control group vs. 94-95% in the intervention group across all three scenarios (p<0.0001). Chest compressions were performed correctly 71-81% of the time in the control group vs. 82-93% in the intervention group in the two scenarios in which they were indicated (p<0.0001). FiO2 was addressed three times more frequently in the intervention group compared to the control group (p<0.001).

Conclusions: Healthcare professionals using a decision support tool exhibit significantly fewer deviations from the Neonatal Resuscitation Program algorithm compared to those working from memory alone during simulated neonatal resuscitation.

Keywords: Decision support tool; Neonatal Resuscitation Program; Simulation.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Algorithms*
Clinical Competence*
Decision Support Techniques*
Education, Medical / standards*
Female
Guideline Adherence*
Humans
Infant, Newborn
Male
Patient Care Team / standards*
Prospective Studies
Resuscitation / education*