Instructors Guide

Introduction: Healthcare has been described as a 'team sport', and good teamwork is
essential to optimal patient care and patient safety.1 This is true in all
areas of healthcare, but is especially important during cardiopulmonary
resuscitation.2 Up to 10% of all newborn infants will require some amount
of resuscitation at birth, with approximately 1% needing intensive
cardiopulmonary resuscitation, including manual ventilation, chest
compressions and medications.3 Good teamwork behaviors have previously been
correlated with higher quality of care during neonatal resuscitation.4
Thus, measures to improve teamwork during neonatal resuscitation are
critically important. Prior research has shown that the addition of a
teamwork and human error curriculum to the 5th edition Neonatal
Resuscitation Program (NPR) course resulted in more frequent teamwork
behaviors during simulated neonatal resuscitations.5,6 The newest edition
of the Textbook of Neonatal Resuscitation includes a discussion of
teamwork/crisis resource management skills.3
The purpose of this interprofessional training curriculum is to
provide training in teamwork and communication for medical providers
engaged in neonatal resuscitation. The curriculum includes a mix of
simulation-based learning and didactic lecture. Participants in the
training could include physicians, nurses, respiratory therapists and
pharmacists.
The didactic teamwork and communication portion is comprised of the
TeamSTEPPS® training curriculum, which was developed by Department of
Defense (DoD) and the Agency for Healthcare Research and Quality (AHRQ).7
The TeamSTEPPS® curriculum focuses on five core competencies of teamwork
which include: team structure, leadership, situational monitoring, mutual
support, and communication. TeamSTEPPS® is widely considered to be the
national standard for medical team training.
The simulation-based training exercises utilizes an 'event-based
approach' and were designed to facilitate learning of the TeamSTEPPS®
concepts by allowing students to apply the competencies of teamwork during
realistic neonatal resuscitation scenarios. The simulations involve a
neonatal resuscitation, wherein the physicians orders an incorrect dose of
epinephrine and nurses provide slow and ineffective compressions. These
performance errors were designed to elicit specific and observable reaction
from teammates- specifically, a challenge from the nurse concerning the
medication dose and a correction of chest compression technique by the
physician leading the resuscitation.
The entire training curriculum can be conducted in 4 to 6 hours. Based
on our preliminary results, we feel the training offers a valuable learning
experience to practitioners. In a small pilot study we were able to
demonstrate significant improvements in teamwork attitudes, knowledge and
skills after participation in the training. We feel others could easily
conduct a similar course at their institution and achieve similar results.
List of all the resource included here:
1. Interprofessional Teamwork Training in Neonatal Resuscitation using
TeamSTEPPS® and Event-based Approach Simulation: Instructor's Guides
2. Interprofessional Teamwork Training in Neonatal Resuscitation Course
Agenda
3. Neonatal Resuscitation Simulation Scenarios
4. Simulation Scenario Nurse Role
5. Simulation Scenario Physician Role
6. TeamSTEPPS® Fundamentals Course lecture - Module 1: Introduction
7. TeamSTEPPS® Fundamentals Course lecture - Module 2: Team Structure
8. TeamSTEPPS® Fundamentals Course lecture - Module 3: Leadership
9. TeamSTEPPS® Fundamentals Course lecture - Module 4: Situation
Monitoring
10. TeamSTEPPS® Fundamentals Course lecture - Module 5: Mutual Support
11. TeamSTEPPS® Fundamentals Course lecture - Module 6: Communication
12. TeamSTEPPS® Learning Benchmarks
13. TeamSTEPPS® Teamwork Attitudes Questionnaire
14. Team Performance Observation Tool
Explanation of when, how, and the order in which to use each resource file:
The Interprofessional Teamwork Training in Neonatal Resuscitation
course was designed to be conducted in a large group composed of healthcare
providers from several specialties involved in neonatal care including
nurses, respiratory therapist, physicians and pharmacists. The course
should be conducted as a half-day course. The course will require a
conference room, or meeting area, with capability of presenting a Power
Point presentation and a room in which to conduct neonatal resuscitation
simulations. Medical equipment required for neonatal resuscitation should
be available within the simulation area, as well as a neonatal simulation
mannequin. The course is composed of simulation-based exercises and
didactic components from the TeamSTEPPS® Fundamental course. See Figure 1
for an overview of the Interprofessional Teamwork Training in Neonatal
Resuscitation course. Figure 1. Interprofessional Teamwork Training in Neonatal Resuscitation
Course Overview. [pic]
To begin the course, the participants should receive a brief
introduction to the course and a review of what will happen during the day,
including a review of the agenda. During this introduction a brief review
of the TeamSTEPPS® Fundamentals Course can be provided by using Module 1-
Introduction. Next, the participants should complete the pre-course
Learning Benchmarks exam and Teamwork Attitudes Questionnaire. The
participants should then be divided into teams of 3 or 4 (comprised of one
physician, one respiratory therapist and 1 to 2 nurses) and go to the
simulation room to conduct the first (pre-course) neonatal resuscitation
with their team. After completing the pre-course exam, questionnaires and
simulation the participants should receive Modules 2 through 6 of the
TeamSTEPPS® Fundamental course. This can be conducted using the standard
TeamSTEPPS® slides. Instructor training in how to conduct the TeamSTEPPS®
Fundamental course should be obtained by way of attendance of a TeamSTEPPS®
training course (http://teamstepps.ahrq.gov/trainingEligibility.htm) prior
to conducting this training. After completion of the TeamSTEPPS®
Fundamental course the participants should complete the post-course
Learning Benchmarks exam and Teamwork Attitudes Questionnaire, and complete
the second (post-course) neonatal resuscitation with their same team. See
the Interprofessional Teamwork Training in Neonatal Resuscitation Course
Agenda for an example of a course agenda.
The simulation-based training exercises utilizes an event-based
approach and were designed to facilitate learning of the TeamSTEPPS®
concepts by allowing students to apply the concepts in realistic
scenarios.8 The simulations involve a neonatal resuscitation, wherein
physicians are told by the course director to request an incorrect dose of
epinephrine and nurses are told by the course director to provide slow and
ineffective compressions. These performance errors were designed to elicit
specific and observable reaction from teammates- specifically, a challenge
from the nurse concerning the medication dose and a correction of chest
compression technique by the physician leading the resuscitation. During
our pilot study we used the Laerdal SimNewB (Laerdal Medical), but any
neonatal mannequin would work. The Neonatal Resuscitation Simulation
Scenarios included here provide details on the history of the infant in the
scenarios and simple instructions on changing the physiologic state of the
mannequins during the simulations. Simulations should take place in a real,
or simulated, delivery room, equipped with standard neonatal resuscitation
equipment. To ensure psychological safety of participants during the
scenarios the facilitator should clearly state prior to the first (pre-
course) simulations that the simulations are not designed to assess medical
management, but rather focus on teamwork and communication skills, and that
specific imbedded errors have been included in the scenario. At the
conclusion of the first (pre-course) simulation, no facilitated debriefing
should be conducted. Instead, the debriefing should be reserved until
after the second (post-course) simulation. Participants should be
instructed to maintain confidentiality regarding what happened during the
first (pre-course) simulation, and directed not to speak to others in their
group about the simulation until the debriefing conducted after the second
(post-course) simulation. At the conclusion of the second (post-course)
simulation a facilitated debriefing should be conducted. The discussion
should focus on team performance during the two simulations, and compare
and contrast team performance between the two scenarios. At the conclusion
of the second (post-course) simulation the imbedded errors should be
clearly identified and the abilities of the participants who committed the
errors in the simulation environment to correctly perform those steps in a
real neonatal resuscitation should be iterated to the team members. Explanation of course materials:
1. Interprofessional Teamwork Training in Neonatal Resuscitation Course
Agenda - example agenda for conducting the course.
2. TeamSTEPPS® Fundamental course - TeamSTEPPS® is a teamwork system
developed jointly by the DoD and AHRQ to improve institutional
collaboration and communication relating to patient safety. The
Fundamentals Course highlights the key principles and concepts of
TeamSTEPPS®. The Fundamentals Course is divided into 6 modules, including
and introduction followed by a module on each of the 5 core competencies
of teamwork.
Course Overview:
Module 1: Introduction
Module 2: Team Structure
Module 3: Leadership
Module 4: Situation Monitoring
Module 5: Mutual Support
Module 6: Communication
3. Neonatal Resuscitation Simulation Scenarios - two neonatal resuscitation
scenari