496 - Retention of Neonatal Resuscitation Skills Amongst Nurses Following a Role Specific Simulation-Based Refresher Course

Poster Number: 496
Publication Number: 496.232

Dina Elachi, NewYork-Presbyterian Komansky Children’s Hospital, New York, NY, United States; Michaela Berroya, NY Presbyterian Hospital, New York, NY, United States; Mary Miller, Weill Cornell Medicine, New York, NY, United States; Lauren Raggio, NewYork-Presbyterian Komansky Children’s Hospital, West Islip, NY, United States; Katherine Roberts, New York Presbyterian Weill Cornell Medical Center, New York, NY, United States; Claudette M. Theuriere, NewYork-Presbyterian Komansky Children’s Hospital, NY, NY, United States; Susan L. Venturini, NewYork-Presbyterian Komansky Children’s Hospital, New York, NY, United States; Charlene Thomas, Weill Cornell Medicine, New York, NY, United States; Jeffrey Perlman, Weill Cornell Medicine, New York City, NY, United States; Catherine Chang, Weill Cornell Medicine, New York, NY, United States

Background: Clinical skills and knowledge acquired during simulation (SIM) training may degrade as early as 6 weeks. An individualized, nursing specific, SIM-based neonatal resuscitation (NR) refresher course was developed and piloted in our institution. The course focused on achievement and retention of mastery performance of the initial portion of the Neonatal Resuscitation Program (NRP) algorithm: initial steps, bag mask ventilation and ventilation corrective steps. Participants demonstrated significant improvement in skills immediately following training.

Objective: To evaluate if participation in a role specific NR refresher course among neonatal intensive care unit (NICU) and labor & delivery (L&D) nurses results in retained performance of the initial portion of the NRP algorithm at 6, 12, or 18 months.

Design/Methods: A NR refresher course was offered every 6 months and consisted of 3 parts: a “pre-teaching SIM” (to assess NR skills), “debriefing” (with feedback and hands-on practice) and a “post-teaching SIM” (to consolidate learning). A low fidelity manikin was used and individual performance during each SIM was documented. Data was scored according to rubric created by research team (Table 1). A score of 12 was defined as ideal performance. Participation in the course was dependent on availability.  Nurses who participated in at least two courses were assigned to a group based on the time interval between courses: Group 1: 6 months, Group 2: 12 months, or Group 3: 18 months. Pre-teaching performance in baseline course was compared to pre-teaching performance in subsequent course.

Results: 31 nurses (17 NICU, 14 L&D) nurses were included.  Post-teaching scores were significantly higher than pre-teaching scores in baseline: p-values 0.003, 0.001, and < 0.001 and subsequent course: p-values .002, .002, and < 0.001 in groups 1,2, and 3 (Table 2). All groups had a median post-teaching score more than 12. Pre-teaching scores were significantly higher in the subsequent course vs baseline in groups 2 (p=0.014) and 3 (p= 0.036). There was no difference in group 1 (Fig 1).Conclusion(s): Participants did not achieve target scores during any pre-teaching SIM.  The combination of individual feedback and hands-on practice significantly improved performance, as all groups surpassed target score immediately following the debrief and displayed significant improvement from pre-teaching score.  Performance declined over time, though not to the original baseline.  Despite this decline, one time participation in this role specific NR refresher course resulted in significantly improved performance at 12 and 18 month follow-up.
Table 1. Scoring Rubric for Neonatal Resuscitation
Table 2. Pre-teaching and Post-teaching SIM Performance During Baseline Course and Subsequent Course (Target Score = 12)