Background: Neonates admitted to cardiac and surgical neonatal intensive care units (NICUs) are at an increased risk of requiring emergency lifesaving interventions that require the use of both Neonatal Resuscitation Program (NRP) and Pediatric Advanced Life Support (PALS) algorithms. Clinicians working within the surgical NICU must be able to access emergency equipment and medications quickly in order to respond to critical situations. A crash cart that integrates human factors principles and supports both the NRP and PALS algorithms is necessary to promote patient safety for this high-risk population. Purpose: A multidisciplinary quality improvement project constructed an optimal crash cart configuration that embedded human factors principles and supported clinical workflow by reflecting both the NRP and the PALS algorithms in an NICU that cares for cardiac and surgical patients. Methods: A crash cart working group including frontline NICU staff, simulation experts, and a human factors specialist was formed within a surgical NICU. Human factors principles were utilized to align the organization of the cart with the NRP and PALS algorithms to increase the efficiency and intuitiveness of the cart. The new crash cart configuration was usability tested through simulation, revised on the basis of clinical feedback, and then implemented in a clinical setting. Data were collected following implementation of the new crash cart to validate that the new configuration was viewed as a significant improvement. The Plan-Do-Study-Act cycle was used to make improvements and capture outcome indicators. Results: Evaluation data collected both during usability simulation testing and in situ within the NICU clinical environment indicated that the revised crash cart scored higher on Likert scale response questions than the previous crash cart. Implications for Practice: Human factors science, in combination with frontline user engagement, should be utilized to create intuitive crash cart configurations, which are then tested in a simulation environment and evaluated in situ in the NICU. Implications for Research: Further research around crash cart design within NICUs that use multiple lifesaving algorithms would add to the paucity of research around the impact of human factors theory in the utilization of lifesaving equipment and medications within this specific population.

BackgroundUse of a central venous catheter(CVC) line is associated with a high risk of infections and complex infusion requirements. Evaluation of professional practices(EPP) is a useful tool in a process of quality improvement and risk management.PurposeOur aim was to assess the differences between user knowledge and practice concerning management of a CVC.Material and methodsThis was a preliminary prospective study in a surgical cardiovascular intensive care unit(ICU) in July 2016. Data were collected by direct observations of CVC settings and standardised interviews with nurses. We focused on the four items in common between the observational study and the answers given by nurses: dressing changes, unused lines management, use of CVC line for blood sample and infusion lines management.ResultsWe observed 61/134 infusion lines and interviewed 31/61 nurses. 100% of nurses declared changing dressings when they becomes loosened or soiled. Only 62% of the dressings had a good performance (29.5% loosened ±19.7% soiled ±11.5% lightly covered) during the observational study. This may have been due to the jugular position of the CVC and the high temperatures in July. 6% of nurses thought the unused lines of the CVC should be equipped with keep vein open infusion and 94% said it should be left with anything. In practice, only 11% were left free and a device was connected in 89%. No keep vein open infusion was observed. 100% of nurses said they performed blood samples on CVC and 100% agreed to flush the infusion line after sampling. In practice, 34% of the lines were soiled (sign of poor or no flushing). This can be explained by the need for a high number of samples. 97% of nurses claimed that catecholamines should be infused alone on the proximal line. 78% were well connected with 50% alone. 50% were infused alone with 22% on another line to avoid haemodynamic disturbances because of different infusion rates.ConclusionThe team seemed to have the knowledge but due to hard working conditions in the ICU, we found divergent results. Despite discrepancies between the two parts of the EPP, a multidisciplinary team of nurses, pharmacists and doctors should propose corrective action and support changes in technique solutions and training in performing changes.No conflict of interest