No abstract

Background: In England neonatal care is delivered within operational delivery networks. Units within these networks are one of three designations (Neonatal Intensive Care, Local-Neonatal or Special-Care Units), based on their ability to care for babies with different degrees of illness or prematurity. With the development of network care-pathways, the most premature and sickest are triaged where possible for delivery in services linked to Neonatal Intensive Care units. This has created anxiety for teams in Local-Neonatal and Special-Care units. Less exposure to sicker babies meant limited opportunities to maintain expertise for when they do unexpectedly deliver at services linked to their own units, and thereafter require transfer for ongoing care, to Neonatal Intensive Care units. Simultaneously, Local-Neonatal and Special-Care teams develop skills in care of the less ill and premature baby which was considered of benefit to all. A need for mutual learning through networking between teams of different designations emerged.Method: An interactive programme, ‘Supporting The Sick Neonate’ was developed in the West Midlands. It focused on equal partnership between unit designations, employing high, medium and low fidelity simulation as the vehicle around which networking between units was centered. Sessions of simulation and debrief were augmented with novel networking time to enable multidirectional learning and understanding of practices. Candidates and facilitators were regarded as participants, spanning different designations. A consultant-focus was adopted to promote long term networking. Qualitative assessment of the programme over four years was captured through -graded and free text surveys.Results: 155 individuals involved in frontline neonatal care participated. 77 were consultants, supported by neonatal trainees, staff grade doctors, clinical fellows, advanced neonatal nurse practitioners and nurses in training. All were invited to participate in the qualitative survey. 79% felt that it was highly relevant; 96% agreed that for consultants this was appropriate adult learning. 98% agreed that consultant training encompassed more than bedside clinical management, including forging communication links between teams. Thematic responses around networking were positive.Conclusion: Simulation augmented with networking time with a consultant-focused model proved successful for networking and shared learning for the Neonatal fraternity in the West Midlands.

Infant abductions from hospital are rare events but make headline news. A US study examined 247 infant abductions between 1983–2006 and found nearly half were abducted from healthcare settings [1]. Abduction risk reduction strategies are also considered during the Care Quality Commission’s inspection of each maternity unit [2]. The baby tagging system was updated in our hospital in April 2020, training undertaken and subsequently reinforced with e-learning. In our hospital, many families have safeguarding concerns. These are considered the highest potential risk for infant abduction so it is essential the system and processes provide protection. The aim of this simulation was to test the processes currently in place for a tagged baby abduction from an inpatient ward to highlight good practices and identify system failures. An activated tag was assigned to a manikin on the transitional care unit. The manikin was removed, in a carrier bag, by a faculty member (‘the abductor’) tailgating a leaving staff member thus preventing the ward doors from automatically locking when the tag is near the sensor. The ‘abductor’ took the lift to the ground floor and walked out of the main entrance within three minutes. Faculty members were placed in transitional care (TC), the main entrance, and another tracking the tag’s location. A timeline of events was recorded and analysed. Simulation participants were debriefed, including staff directly involved, parents on TC, front of house staff, and senior managers. It was evident from the debriefing that this caused significant distress to some staff members who felt helpless and uncertain when faced with this scenario. It highlighted how quick and easy it is to leave the hospital with a baby. Important human factors were identified including discrepancies between emergency call requests and responses, and poor knowledge about the abduction of baby policy. System problems were found: hospital ‘lockdown’ locked internal doors preventing responder actions but not all external doors; and the tagging system did not respond as expected – locking the doors to the ward and an inaccurate final tag location. Multiple deficiencies in the system were found so an action plan has subsequently commenced. New external doors have been added to automatic lockdown and a new main entrance door system proposed. Tagging engineers are addressing the automatic locking of internal doors and tag location, switchboard calls are to be standardised, and the standard operating procedure is being reviewed and recirculated. 1. Burgess AW, Carr KE, Nahirny C, Rabun JB Jr. Nonfamily infant abductions, 1983–2006. Am J Nurs. 2008 Sep;108(9):32–8. doi: 10.1097/01.NAJ.0000334972.82359.58. PMID: 18756155. 2. Care Quality Commission NHS IH Maternity core service framework v7 (2018)

Neonates in intensive care are vulnerable to colonisation and invasive infections from multi-resistant gram-negative bacteria [1]. In 2021 our neonatal unit (NNU) fell victim to an ESBL-Klebsiella outbreak. An outbreak control plan was formulated that included education; hand-hygiene and cleaning auditing; cohorting infants; mass screening infants and environment; and reduction of equipment in clinical areas. Our NNU has an active multidisciplinary simulation programme. Simulation is an effective educational tool to increase competence of healthcare providers [2]. We wanted to use simulation to highlight the ease of transmission of particles from a colonised infant. The simulation involved a preterm 28-week infant corrected to 35-week gestation with numerous desaturation episodes. The baby was known to be colonised with pseudomonas. A ‘monitored’ low-fidelity manikin was placed in a cot in an isolation room. Candidates were unaware that the manikin was covered with ultraviolet powder. The manikin had numerous desaturation and bradycardic episodes necessitating airway and breathing support, clinical assessment, and septic screen. The spread of powder was assessed afterwards with a black-light. The simulation lasted just 8 minutes. There were exemplary unprompted infection-prevention measures with appropriate handwashing and personal protective equipment. Despite this the powder spread to staff facemasks, stethoscope, resuscitation equipment, patient trolley, and monitor. This demonstrated the ease of transmission of particles to other surfaces despite adherence to infection prevention policies. Most striking was the transmission to candidates’ facemasks which are not routinely changed, and could be a potential risk of carriage of microbes to other infants. 1. Patel SJ, Green N, Clock SA, Paul DA, Perlman JM, Zaoutis T, Ferng YH, Alba L, Jia H, Larson EL, Saiman L. Gram-Negative Bacilli in Infants Hospitalized in The Neonatal Intensive Care Unit. J Pediatric Infect Dis Soc. 2017;6(3):227–230. 2. Aggarwal R, Mytton OT, Derbrew M, Hananel D, Heydenburg M, Issenberg B, MacAulay C, Mancini ME, Morimoto T, Soper N, Ziv A. Training and simulation for patient safety. BMJ Quality & Safety. 2010;19(Suppl 2):i34–43.

Research Across the Midlands (pram) 4 . 1 Birmingham Women's and Children's NHS Foundation Trust; 2 The Royal Wolverhampton NHS Trust;