Context This improvement project was undertaken at Derriford Hospital, a tertiary neonatal centre in Devon, England.
Problem This unit runs regular ward-based multidisciplinary simulated resuscitation scenarios to improve staff preparedness for managing sick neonates. A recurrent theme in feedback from junior doctors following these scenarios was that they did not feel comfortable with navigating the neonatal emergency resuscitation trolley and could improve the speed in which they could find and assemble equipment such as umbilical lines. No formal strategy was devised for addressing this problem, and doctors were advised to familiarise themselves with the trolley, however this did not always reliably occur.
Assessment of the problem Following discussion with staff, it became apparent that nursing staff were more confident with the contents of the trolley, as they are responsible for performing the daily checks of its content. Junior doctors were not regularly exposed to the trolley as simulated scenarios take place on an alternate-weekly basis, with perhaps 2 or 3 doctors taking part each time. Staff thought exposure was the key to increasing confidence with equipment.
Intervention A game was designed to provide junior doctors with more exposure to the trolley, that would be less time consuming than full resuscitation scenarios and therefore take place more frequently.
Study Design “Resus Trolley Treasure Hunt” involves a nurse or junior doctor being presented with a short list of equipment and being asked to assemble it under timed, but informal (fun!) conditions. A colourful leader-board was created to add interest and a competitive element to the game.
Strategy for Change Participation was entirely voluntary. Nursing staff and junior doctors were encouraged to invent lists of equipment for each other to hunt. The leader-board was displayed in the nursing and doctors office and staff could change their place as their performance improved.
Measurement The leader-board displayed the performance times of individual members of staff, and staff were encouraged to have multiple attempts to try and improve their performance.
Effect of change A pilot run has shown this game to be a feasible method for quality improvement. Junior doctors will also be asked to provide qualitative feedback about how they feel about sourcing and assembling equipment in neonatal emergencies. One problem encountered was finding protected time for the game to take place in on a regular basis.
Lessons learnt A quality improvement project can be fun as well as contributing to quality of care for patients. This improvement project was the idea of junior staff as a result of a day-to day problem in a clinical area which adds to its credibility and sustainability. Involving medical and nursing staff together also contributed to its success.
Message to others Seek and value ideas and contributions of junior medical and nursing staff. If possible make your improvement project fun to encourage uptake and participation. It is hoped that this project will lead to higher levels of confidence in handling equipment, improve morale, and improve the performance of the Intensive Care team in managing neonatal emergencies.
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