Analysis and classification of errors made by teams during neonatal resuscitation.

AIM: The Neonatal Resuscitation Program (NRP) algorithm serves as a guide to healthcare professionals caring for neonates transitioning to extrauterine life. Despite this, adherence to the algorithm is challenging, and errors are frequent. Information-dense, high-risk fields such as air traffic control have proven that formal classification of errors facilitates recognition and remediation. This study was performed to determine and characterize common deviations from the NRP algorithm during neonatal resuscitation. METHODS: Audiovisual recordings of 250 real neonatal resuscitations were obtained between April 2003 and May 2004. Of these, 23 complex resuscitations were analyzed for adherence to the contemporaneous NRP algorithm and scored using a novel classification tool based on the validated NRP Megacode Checklist. RESULTS: Seven hundred eighty algorithm-driven tasks were observed. One hundred ninety-four tasks were completed incorrectly, for an average error rate of 23%. Forty-two were errors of omission (28% of all errors) and 107 were errors of commission (72% of all errors). Many errors were repetitive and potentially clinically significant: failure to assess heart rate and/or breath sounds, improper rate of positive pressure ventilation, inadequate peak inspiratory and end expiratory pressures during ventilation, improper chest compression technique, and asynchronous PPV and CC. CONCLUSIONS: Errors of commission, especially when performing advanced life support interventions such as positive pressure ventilation, intubation, and chest compressions, are common during neonatal resuscitation and are sources of potential harm. The adoption of error reduction strategies capable of decreasing cognitive and technical load and standardizing communication - strategies common in other industries - should be considered in healthcare.

Making the move: from traditional neonatal education to simulation-based training.

Resuscitating neonates is a critical skill set for obstetric and neonatal care providers. The principles, knowledge, and skills of neonatal resuscitation as developed by the Neonatal Resuscitation Program are taught in a variety of ways to enhance learning including didactic, CD-ROM, hands-on-task training, and mock codes. Despite this variety of educational methods, studies have called into question the ability of the care provider to adequately perform neonatal resuscitation. Simulation-based training is gaining more recognition in healthcare as a method of training that incorporates adult learning theory, real-time clinical situations, and video debriefing of the scenario to allow a healthcare team an opportunity to practice skills and evaluate their performance. The Neonatal Resuscitation Program is including simulation-based training as an educational methodology to promote skill acquisition and performance enhancement in its providers.

Simulation-based medical error disclosure training for pediatric healthcare professionals.

Ethical and regulatory guidelines recommend disclosure of medical errors to patients and families. Yet few studies examine how to effectively train healthcare professionals to deliver communications about adverse events to family members of affected pediatric patients. This pilot study uses a preintervention-postintervention study design to investigate the effects of medical error disclosure training in a simulated setting for pediatric oncology nurses (N=16). The results of a paired t test showed statistically significant increases in nurses' communication self-efficacy to carry out medical disclosure (t = 6.68, p < .001). Ratings of setting "realism" and simulation effectiveness were high (21 out of 25 composite score). Findings provide preliminary support for further research on simulation-based disclosure training for healthcare professionals.

High-fidelity simulation-based training in neonatal nursing.

Simulation-based training is a novel approach that facilitates the use of higher order thinking skills. Simulation-based training challenges medical professionals to develop cognitive, technical, and behavioral skills through the use of mannequins, working medical equipment, and human colleagues. During scenarios, trainees must make use of their knowledge base, analyze and synthesize factors contributing to the crises, and evaluate the effects of their actions. Feedback indicates that simulation-based training programs are more pertinent to and better accepted by adult learners than traditional programs. The instructional methodologies used in simulation-based training programs are more in line with the tenets of adult learning.