G161(P) Intubation-skill training and record-keeping (I-star)- to improve intubation in neonates in a DGH. (25th October 2020) - Oommen, A
Abstract : Aim and Objectives: To assess the quality of intubation To assess confidence of junior doctors in intubation and opportunity for training To assess Record keeping of Intubation procedure on NICU Methods: Initial retrospective data collection done in February 2019, for the practice of intubation which happened over previous 6 months. Subsequently an action plan was formulated and strictly followed. The changes brought by this new action was studied prospectively over 4 months from April 2019 till July 2019. Action plan included: Implementing updated guideline for intubation Availability of airway adjuncts Weekly consultant led simulation training for junior doctors and nurses. Change of practice was constantly encouraged with encouragement of junior doctors to do procedures. Pre–checklist for intubation and documentation sheet were introduced and everyone in the team educated to use those. Results: In the initial retrospective study 28 intubations were analysed and subsequent prospective study included 13 intubation. ETCO2 use to confirm ETT position had increased from 57% to 100% Registrars succeeding in intubation became 100% (previously 84%) Only 57% neonates were intubated in 1st attempt earlier which improved to 85% Earlier we required anaesthetic help in 7% but in the repeat study none required Premedication use during intubation had increased from 61% to 100% with the use of pre-checklist With improvement in practice around intubation, there was no accidental extubation, which was earlier noted to be around 14% 30% of the times junior doctors (SHO) were given the opportunity to intubate in comparison to 3% earlier Confidence in BVM ventilation among SHOs and intubation among registrars are significantly high in the repeat survey, due to continued teaching and simulation training. Conclusions: Effective simulation, training, education and perseverance in change in practice improved the intubation in neonates in DGH and confidence of doctors and nurses working in the unit. Improvement is likely to improve outcome of the babies.