Implementation and effectiveness of a video-based debriefing programme for neonatal resuscitation.

BACKGROUND: Approximately 5%-10% of newly born babies need intervention to assist transition from intra- to extrauterine life. All providers in the delivery ward are trained in neonatal resuscitation, but without clinical experience or exposure, training competency is transient with a decline in skills within a few months. The aim of this study was to evaluate whether neonatal resuscitations skills and team performance would improve after implementation of video-assisted, performance-focused debriefings. METHODS: We installed motion-activated video cameras in every resuscitation bay capturing consecutive compromised neonates. The videos were used in debriefings led by two experienced facilitators, focusing on guideline adherence and non-technical skills. A modification of Neonatal Resuscitation Performance Evaluation (NRPE) was used to score team performance and procedural skills during a 7 month study period (2.5, 2.5 and 2 months pre-, peri- and post-implementation) (median score with 95% confidence interval). RESULTS: We compared 74 resuscitation events pre-implementation to 45 events post-implementation. NRPE-score improved from 77% (75, 81) to 89% (86, 93), P < 0.001. Specifically, the sub-categories "group function/communication", "preparation and initial steps", and "positive pressure ventilation" improved (P < 0.005). Adequate positive pressure ventilation improved from 43% to 64% (P = 0.03), and pauses during initial ventilation decreased from 20% to 0% (P = 0.02). Proportion of infants with heart rate > 100 bpm at 2 min improved from 71% pre- vs. 82% (P = 0.22) post-implementation. CONCLUSION: Implementation of video-assisted, performance-focused debriefings improved adherence to best practice guidelines for neonatal resuscitation skill and team performance.

[Deep venous thrombosis in intravenous drug addicts]. / Dyp venetrombose hos intravenøse stoffmisbrukere.

Long-lasting intravenous drug abuse causes sclerosis of the superficial venous system. Many drug abusers thus choose to inject into the major veins of the groin or neck. Such practice may, among various other complications, cause deep venous thrombosis. We describe four patients with venous thrombophlebitis localised at the ileo-femoral junction. All patients were intravenous drug abusers, who for many years had injected various drugs into the groin. Two patients suffered a relapse after the treatment was discontinued. One patient had nonfatal pulmonary embolism. All four patients were treated with low-molecular-weight heparin. Three patients were later treated with warfarin, but, owing to bad compliance, this treatment had to be discontinued quite soon in two cases. We conclude that the management of deep venous thrombosis can be difficult in intravenous drug abusers. This is due mainly to poor venous access, the risk of transmitting blood-borne viruses to health personnel, asocial behaviour, and poor compliance. For most patients, we advocate administration of low-molecular-weight heparin for at least three months. Supporting treatment with metadone should be considered in selected cases.