Pitstop Resuscitation™ Lap One The Resuscitation Trolley R HAYWARD, A HAYWARD, L CLEATON Neonatal Unit, UHW

Background 5 to 10% of neonates require some degree of resuscitation at delivery1,2 1% to 10% neonates born in hospital are reported to require assisted ventilation3 Efficient & effective resuscitation at delivery  optimal neonatal outcome  reduces long term complications Clearly defined roles within the resuscitation team Direct access to an organised equipment system4

Pitstop resuscitationTM 3 laps: 1. Resus trolley streamlining 2. Neonatal team footprint 3. Pit stop resuscitation team

TROLLEY NLS guidelines ‘Organisation of equipment & ease of accessibility is paramount to the time-dependent nature of resuscitation and its subsequent outcome’ Equipment currently stocked on the resuscitation trolley was audited. A questionnaire was completed by neonatal staff to ascertain their familiarity with the existing trolley (including the location of essential items of equipment) and identify difficulties with the current lay-out during resuscitations. Accessibility of equipment in the trolley in a simulated resuscitation was also analysed using video footage.

Questionnaire TROLLEY 90% Resuscitation trolley is a key piece of equipment in resuscitation 70% Equipment is organised in a logical manner 40% Know exactly where to find a specific piece of equipment 20% Have experienced a delay in: intubation / gaining IV access / provision of drugs 1/5 can’t find specific equipment on the resus trolley

Streamlining 18 Tegaderms 6 cord clamps 3 strips of spare laryngoscope bulbs 20 Chloropreps 17 pairs of sterile gloves 19 UVCs 4 different types of yellow cannulae 40 syringes

AIRWAY MANUAL AIRWAY BASIC AIRWAY INTUBATION Saturation probes (< 3kg & > 3kg) X2 Stethoscope (neonatal) x 1 Laedal Bag & Green Tubing Face Masks 00, 01 X 2 Suction Catheters- 6F, 8F, 10F (X4) x 2 Y connectors for suction Yankauer Catheters mini & paed Airways- 000, 00, 0, 1 Laryngoscope Handles Laryngoscope Blades- 00, 0, 1, Laryngoscope Batteries 1 pack Sterile Introducers x 5 E.T Tubes- 2.5, 3, 3.5, 4, 4.5 x 2 I Gel x 1 Neostat (CO2 Detectors) Neobars 2 each size Neobar Fixing Kit including: Cavilon x 3 Sterile scissors x2 Neobar measuring tape x 2 Elastoplast strips (several) Trache tapes   A revised ‘stream-lined’ resuscitation trolley was subsequently implemented containing essential equipment in accordance with NLS guidance and after consulting lead neonatal resuscitation personnel. Drawers were colour-coded and a user manual constructed for ease of reference. Two months after implementation the trolley was re-audited and staff completed a second questionnaire to identify improvements. MANUAL

Re-audit & questionnaire 21 items had been added to the streamlined trolley on re-auditing   Initial audit Re-Audit 1.     Key piece of equipment 92 100 2.     Easily accessible 95 3.     Organised in a logical manner 70 4. Ability to find a specific piece of equipment 40 5.     Delayed intubation of a neonate 15 6.     Delayed IV access 21 7.     Delayed provision of drugs 2014 March Auditing of trolley Questionnaires April 24th 2015 Williams meeting May 20th implemented June 9th presented and feedback obtained July 30th re-audited – inventory and questionnaires 21 = 7 neobars. 9 premmie hats, 2 x 5ml saline Positive comments: New layout I far more easy to use, much simpler way of finding what is needed – definitely heading in the right direction Much better organised and easier to use than the previous trolley New trolley - much more user friendly and clearly labelled The trolley is far better organised in a logical manner and even when called to crash bleeps one after another it was fab and I knew exactly where to find everything

AIRWAY CIRCULATION DRUGS PREMATURE DELIVERIES SURGICAL CHEST DRAIN Williams – visualise drawers, familiarisation with photos and a manual, identify what’s needed and what has been used PREMATURE DELIVERIES SURGICAL CHEST DRAIN

The future Working in collaboration with a company that specialises in making pre-formed linings

Conclusions & recommendations The Pitstop resuscitationTM trolley has provided a streamlined storage system - logical - user-friendly - reduced delays in the provision of equipment A consistent method of storing resuscitation throughout neonatal units (local/national) Familiarity with equipment on the resuscitation trolley and its location within the trolley is a pre-requisite for enabling the rapid provision of specific equipment during a neonatal resuscitation Logical layout, visualised (manual, photos), It is proposed that a consistent method of storing resuscitation equipment would promote familiarity of use (as staff often work in different neonatal units) and optimise the time-efficient provision of equipment during resuscitation.

Questions Acknowledgements: References: Williams Martini Racing Polyformes Ltd References: 1. ILCOR Advisory Statement: Resuscitation of the Newly Born Infant: An Advisory Statement From the Pediatric Working Group of the International Liaison Committee on Resuscitation. Kattwinkel J, Niermeyer S, Nadkarni V, Tibballs J, Phillips B, Zideman D, Van Reempts P and Osmond : Circulation (1999);99:1927-1938 2. Neonatal Resuscitation Program: First Golden Minute, Choudhury P, Indian Paediatrics (2009); 46: 7-9 3. Palme-Kilander C. Methods of resuscitation in low-Apgar-score newborn infants: a national survey. Acta Pediatr. (1992);81:739 –744. 4. Resuscitation Team Organization for Emergency Departments: A Conceptual Review and Discussion. Mellick LB, Adams BD. The Open Emergency Medicine Journal. (2009); 2: 18-27 Max Constanduros – Press Officer Gemma Fisher – Human Performance Lead Grove, Wantage, Oxford