Audit of Equipment Stocked on Resuscitaires in a Busy Maternity Unit in Wales Dr Emmanuel Oluyomi (SHO) RGH Dr AnneMarie Proctor (ST5) RGH Dr Maria Tsakmakis (Cons Neonatologist) RGH

Introduction Small percentage of babies require resuscitation at birth but can be difficult to predict which babies will require resuscitation prior to delivery All resuscitaires in maternity units should be fully equipped and ready for use In 2013 a standard checklist of equipment that should be available on all resuscitaires was agreed between the neonatal and maternity teams

Aim Aim – to establish how well stocked and ready for use all resuscitaires are in the main delivery suite of a busy maternity unit in Wales Objectives To assess whether all resuscitaires are fully stocked If not fully stocked to identify which items are missing To make recommendations based on the findings

Gold standard Checklist On Resuscitaire I n Box In Drawer Light and clock working Oxygen working with tubing and face mask Suction working with blue and black suction catheters Oxygen cylinder more than half full >500psi Neonatal stethoscope Ambubag micronate small mask hung on back Ambubag neonate mask One box Narcan 400mg One box of Sodium Bicarbonate 4.2% In date drug box Laryngoscopic blades X2 Portex paediatrics tubes sizes 2.00mm, 2.5mm, 3.00mm, 3.5mm and 400mm Intubation stylet Yankauer sucker Scissors x1 Neonatal airways sizes: 0x1(grey), 00x1(blue), and 000x1(grey) Neonatal Circuit (Tom Thumb) x2 NeoPEEP x2 Oxygen tubing x3 Suction Catheters Black x3 and Blue x3 Baby hats Plastic bag for delivery <29 weeks Oxygen masks small, medium and large x1 of each size Scissors x3 Cord clamps x3

Method of Data Collection Standard checklist used as the gold standard Performed over a 1 calendar month period, June 27 - July 25, 2014 Each resuscitaire on MDU checked 12 times on random unannounced occasions At no time was any resuscitaire checked more than twice within 24hours. Total of 108 checks recorded (9 resuscitaires x 12 occasions) Items present but not in the required number as detailed on the checklist were marked ‘incorrect’.

Results To help interpretation, data is reported within the 3 checklist subheadings: Section 1 : Items on the resuscitaire criteria Section 2: In the box criteria Section 3: Items in the drawer criteria

Results Continued In 108 episodes the full criteria (excluding NaHCO3) were only met 6.5% of the time. Including NaHCO3, ZERO %! Most rooms always fully stocked with required ETTs. BUT Theatres (which are arguably the most likely rooms to require ETTs) were stocked <100% of the time For multiple criteria eg. 3 x oxygen tubing – 3 sets rarely found in the drawer. However 100% of resuscitaires always had at least 1 x oxygen tubing

Recommendations Update criteria - remove items not stocked deliberately e.g. NaHco3 - review need for multiple items e.g. 3x oxygen tubing - Naloxone 400mg -> 400mcg Identify who is responsible for re-stocking Increase awareness of checklist & need to maintain it Carry out small quality improvement checks monthly Full re-audit in 6 months.

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