Preparedness of Western Cape ALS providers to provide clinical stabilisation and intensive care for neonates during the patient journey

Abstract

The management and intensive care of neonates is inherently prone to adverse events, particularly as such management often involves pre-term neonates in distress – this means they have been born too early and their frail bodies require external support in order to survive. In the Western Cape high-risk neonates who are being referred from one neonatal intensive care unit (NICU) to another such unit or from primary and secondary hospitals to NICU are transported by ALS providers. However, there is a paucity of evidence relating to the preparedness of these ALS providers for the management and continuum care of these critically ill neonates. This study showed the general lack of neonatal exposure as the clinical management of critically ill neonates ranged from once in six months (n = 17, 11.7%) to a group of 6.9% (n = 6) who indicated that they had never managed critically ill neonates. The lack of frequency of employing the critical ALS skills of neonatal intubation (n = 62, 42.8%) and neonatal CPR (n = 49, 33.8%) cited, reflected the lack of opportunity to use such skills frequently in the pre- hospital environment. Only 9.7% (n = 14) of the respondents indicated they had the necessary specialised monitoring equipment to safely transfer neonates and only 14.5% (n = 21) of the respondents felt “well-prepared” to manage critically ill neonates. There is an urgent need to standardise both the theory and the practicum components for all ALS provider neonatal training programmes. The ideal would be the establishment of a mentorship programme, supervised by neonatologists. Additional neonatal short course/refresher training is also needed which includes the design of Continued Professional Development (CPD) accredited activities. In order to improve patient safety, the procurement of sufficient specialised neonatal intensive care equipment and disposables, especially for the rural ALS providers, should be prioritised. Elements before, during and after the inter-facility transfer of a critically ill neonate by ALS providers were explored. This study suggests that these factors may impact on the emotional and mental preparedness of the ALS providers, possibly hampering their ability to provide optimum care.

Developing a South African curriculum for education in neonatal critical care retrieval: An initial exploration

“…The need for additional education in neonatal CCR was described by the prospective student group. This result was also reported by Ismail et al [11] in a descriptive study where ALS providers from the Western Cape, South Africa felt that they require additional exposure and training in neonatal transfers. The same result was also reported by Ashokcoomar et al [22] in a descriptive study where seven neonatologists from the state sector in South Africa indicated that ALS providers who transfer neonates require specialised education.…”

“…10 Apply and analyse a variety of methods used for the monitoring of a critical neonate during retrieval and transport. 11 Describe the physiological effects that the different modes of transport could have on the neonate and apply methods to mitigate potential risks to the neonatal patient during transport. 12 Describe and demonstrate the monitoring, care and management of a variety of ventilation modes and methods as they relate to neonatal critical care and transport.…”

“…The study was conducted in the LMIC setting of South Africa where the transfer of neonates are mostly conducted by ALS providers with variable education backgrounds [10] and these ALS providers are of the opinion that they need additional education and specialised equipment to conduct these transfers safely [11]. The participants represented various provinces across South Africa.…”

“…The physiological stressors experienced by the neonate during transport may lead to clinical deterioration or instability, making transfer inherently high risk in nature [2][3][4][5][6][7][8][9]. A lack of specialised equipment [2,5,6,8,[10][11][12] and time delays for transfer and stabilisation [2,6,[9][10][11][13][14][15] have all been associated with an increased incidence of adverse events. Similarly, the level of education and training of the transferring provider has been shown to be one of the biggest predictors of adverse events and eventual patient outcome [2, 5-11, 13, 14].…”

“…While previous work have described the perceptions of providers on general paediatric [10] and neonatal [11,21,22] interfacility transfer, this has not been done for CCR. CCR refers to the stabilisation and transport of critically ill or injured patients from a healthcare facility where the healthcare requirements of the patient outweigh the diagnostic or treatment abilities to an appropriate facility where these are available [23].…”