Aims In-situ simulation training indicated the need for accurate setup of peak inspiratory pressure (PIP) and positive end expiratory pressure (PEEP) prior to newborn resuscitation. Our project aimed to improve the quality of team learning from latent inaccuracies in PIP and PEEP settings, to reduce harm and improve outcomes for newborn infants through a series of targeted interventions.

Methods During 2016, we have undertaken a quality improvement project to measure baseline set-up of resuscitaires in the delivery suite and post-natal wards. The first pdsa (plan do study act) cycle was performed through a prospective daily check of all resuscitaires (n=12) PIP and PEEP settings over a one week period. When issues were identified, an ‘on the spot’ one to one simulation training of midwifery staff was performed. During the second pdsa cycle we introduced ‘resuscitaire flashcards’ to support all team’s learning and to be used as aid memoire for the daily safety checklist on delivery suite.

Results During the first pdsa cycle, 10% of the resuscitaires PIP was high (>30 cm H2O) and PEEP was set incorrectly in 48% of the cases. Inaccuracies in PEEP were either too high flow settings (>5 cm H2O) in 22% of cases or too low flow settings (<5 cm H2O) in 26% of the cases. Following the interventions, 100% of PIP was correctly set and only 11% of PEEP was inaccurate (high flow for PEEP setting). Overall, this quality improvement programme led to 76% improvement in performance.

Conclusion Targeted quality improvement interventions through simulation have improved PIP and PEEP resuscitaires settings. This led to a reduction in latent errors and improved the care given to newborns requiring resuscitation at birth.