Effect of skill drills on neonatal ventilation performance in a simulated setting- observation study in Nepal

Abstract

AimMaintaining neonatal resuscitation skills among health workers in low resource settings will require continuous quality improvement efforts. We aimed to evaluate the effect of skill drills and feedback on neonatal resuscitation and the optimal number of skill drills required to maintain the ventilation skill in a simulated setting.MethodsAn observational study was conducted for a period of 3 months in a referral hospital of Nepal. Sixty nursing staffs were trained on Helping Babies Breathe (HBB) 2.0 and daily skill drills using a high-fidelity manikin. The high-fidelity manikin had different clinical case scenarios and provided feedback as “well done” or “improvement required” based on the ventilation performance. Adequate ventilation was defined as bag-and-mask ventilation at the rate of 40–60 breaths per minute. The effective ventilation was defined as adequate ventilation with a “well done” feedback. We assessed the correlation of number skill drills and clinical case scenario with adequate ventilation rate using pearson’s correlation. We assessed the correlation of number of skill dills performed by each participant with effective ventilation using Mann Whitney test.ResultsAmong the total of 60 nursing staffs, all of them were competent with an average score of 12.73 ± 1.09 out of 14 (p < 0.001) on bag-and-mask ventilation skill checklist. Among the trained staff, 47 staffs participated in daily skill drills who performed a total of 331 skill drills and 68.9% of the ventilations were done adequately. Among the 47 nursing staffs who performed the skill drills, 228 (68.9%) drills were conducted at a ventilation rate of 40–60 breathes per minute. There was no correlation of the adequate ventilation with skill drill category (p = 0.88) and the level of skill performed (p = 0.28). Out of 47 participants performing the skill drills, 74.5% of them had done effective ventilation with a mean average of 8 skill drills (SD ± 4.78) (p-value- 0.032).ConclusionIn a simulated setting, participants who had an average skill drill of 8 in 3 months had effective ventilation. We demonstrated optimal skill drill sessions for maintain the neonatal resuscitation competency. Further evaluation will be required to validate the findings in a scale up setting.

Neonatal Resuscitation Skill-Training Using a New Neonatal Simulator, Facilitated by Local Motivators: Two-Year Prospective Observational Study of 9000 Trainings

“…One important aspect regarding simulation-based training in neonatal resuscitation is the amount of training needed to improve and maintain skills and to translate acquired skills into clinical practice. A previous study indicates that an average skill drill of eight in three months leads to effective simulated ventilation, but more research is needed to find the optimal level of training frequency [ 29 ]. This is important for optimizing cost-benefit aspects of frequent on-site simulation-based training where time and resources are scarce, and training must fit in with clinical tasks.…”

Adaptation of Essential Care for Every Baby educational program to improve infant outcomes in the context of Zika

“…While this was not done at each site, precluding firm conclusions, these results do fit with what is commonly known about knowledge and skills after an initial workshop—they decline if not practiced regularly. There is evidence to support the use of low dose, high frequency practice to improve skills retention [ 14 – 16 ]. Ideas generated by participants on how to implement such practice included using the “review key knowledge” section of each page of the provider guide to frequently test skills with a partner, and incorporating ECEB into pre-service education of nursing trainees and house staff officers by dividing the course into hour-long sessions.…”

A narrative review of course evaluation methods for continuing professional development: The case of paediatric and neonatal acute-care in-service courses in low and lower-middle income countries: BEME Guide No. 76

“…Refresher training (Bang et al 2016), daily skills training (Gurung et al 2019) or structured 'On the Job Training' by an HBB champion (Drake et al 2019) all increased retention. For example, the group with monthly OSCEs for 6 months had greater odds of passing than less frequent practices (Tabangin et al 2018).…”