The Effect of a Resuscitation Drill on Nursing Confidence and Performance in the Labor Ward

By LI Chui Yan, Fanessca, RN, RM, IBCLC, BN, MSc(Obstetric), FHKAN(Midwifery) & NRP Instructor, Department of Obstetrics

Background

The textbook of neonatal resuscitation program stated that the incident rate of newborn requiring resuscitation was quite low, at about 0.4% of them received chest compression or emergency medications after birth1. In the current 2.5 years in our nurseries, it’s approximately 0.024% of our total births in a year which neonates required extensive resuscitation. On the other hand, it would be stressful for our staff once neonatal resuscitation had happened because of lack of occurrence. Besides, 86.4% of midwives in the labor ward had more than 5 years experience, however 77.3% of them could not participate in any extensive neonatal resuscitation in the past three years. There was also no regular neonatal resuscitation drill to be carried out for them. As a result, a survey was carried out in the labor ward to collect their demographic data and their perception of neonatal resuscitation. 22 of 24 midwives completed the survey and it found that most of them were having valid NRP provider certificates, but their confidence, knowledge and skills subjectively was about only 3.4 over 5.

Purpose and Problem Statement

The aim was to ensure high quality neonatal resuscitation and patient safety in clinical emergencies. Therefore, for the population of midwives in the labor ward, the neonatal resuscitation drills were implemented for them. Compared with the current situation, the desired outcome would be improved performance and confidence. As a result, the PICO question was “does a neonatal resuscitation drill affect nursing confidence and performance in the labor ward?”

Implementation Plan

First, grouping 4 to 5 midwives carried out neonatal resuscitation drill and made a video to facilitate the evaluation of their performance. Second, we had a debriefing session to provide objective feedback on their performance in order to promote reflective thinking. Third, they carried out the scenario again and made a second video. Fourth, they completed a post-intervention survey with the same questions about their perceptions of neonatal resuscitation. At last, their performance were evaluated by reviewing the videos of each group. The numbers of critical interventions carried out in the drills were documented.

Results

All the average scores about their confidence, knowledge and skills in the post intervention survey significantly increased to at least 4.2 over 5 after the drill. Midwives in the labor ward agreed that drills bought positive influence on their performance. After reviewing the video, the average score of their performance was 4.5 over 10 at the beginning. After the debriefing sessions, their performance average score  was increased significantly to 8.5 over 10.

Recommendations and Next Steps

In the short term could be that the drill can be involved with more colleagues, such as nurses in antenatal, postnatal ward and Resident Medical Officers in order to promote our collaboration. Besides, the baby Manikin could not be intubated or even performed Umbilical Venous Catheter insertion at this moment. We will have the higher fidelity baby and mother manikins soon, then we can implement some advance skills in the drill and more complicated scenarios.  

In long term, we have to evaluate colleagues’ satisfaction after every drill, in order to optimize their level of engagement. Also, we have to verify our colleagues’ knowledge and skill retention three months later. Then according to their performance, we would adjust the frequency of the drills in a long run. Moreover, each individual skill or micro technique could be evaluated in a long run.