302 - A Needs Assessment: Evaluating Labor and Delivery Nurses Delivery Room NRP Performance

Poster Number: 302
Publication Number: 302.347

Michael Zujkowski, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Shanmukha Mukthapuram, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Matthew W. Zackoff, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Jennifer M. Brady, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Beth Ann Johnson, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Shelley Ehrlich, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Chunyan Liu, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Qin Sun, Cincinnati Children's Hospital Medical Center, mason, OH, United States

Background: Labor and delivery (L&D) nurses are often responsible for initiating the critical first steps of Neonatal Resuscitation Program (NRP).  Rates of NRP compliance in this group of frontline providers have not been well described.  Identification of knowledge gaps and underlying reasons for NRP non-compliance will aid in designing future educational interventions to ultimately improve neonatal outcomes.

Objective: To conduct and evaluate summative simulations of L&D nurse NRP performance to objectively identify areas of deficit as a formal needs assessment for future educational interventions.

Design/Methods: A convenience sample of 37 L&D nurses from two delivery hospitals were enrolled.  Participants completed a pre-survey capturing years of experience as a L&D nurse, prior exposure to NRP training, and comfort level in performing neonatal resuscitation.  Survey data was collected via free response questioning and 6-point Likert Scales.  Participants then completed a video recorded standardized manikin-based simulation of a neonatal delivery room resuscitation.  NRP adherence was assessed via video review using an Observed Structured Clinical Examination (OSCE) assessment tool with prior validity evidence.  Metrics included percentage of correctly completed OSCE items, time to initiation of positive pressure ventilation (PPV), and achievement of effective PPV (defined as achieving chest rise on the manikin with attempted ventilation).  Descriptive statistics were used for analyses.

Results: The median years of L&D experience for the participants was 2.5 years, with a median of 1 year since last NRP training and level of confidence of 4 (Table 1). The median number of correctly completed items on the OSCE checklist was 12/21 (57.1%).  The median time to initiate PPV was 55 seconds, with 56.8% of participants (21/37) initiating PPV within the NRP target of 60 seconds.  The median time to effective PPV was 109 seconds, with 32.4% of participants (12/37) achieving this within 60 seconds (Table 2).  Years of L&D experience had a strong correlation with percentage of correctly completed OSCE items (r=0.63) and a moderate correlation with level of confidence (r=0.41, Figure 1).

Conclusion(s): Despite high self-perceived confidence in NRP skills, we identified that initiating and achieving effective PPV within the desired 60 second time window of NRP remains an area for significant improvement for L&D nurses.  Next steps include the design and implementation of targeted training within the NRP recertification window to address these performance gaps.