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

2. 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

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

4. 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.

5. 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

6. 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

7. 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

8. 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

9. 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

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

11. 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.

12. 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:
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