“Baby Steps” for Baby Breaths–How Incremental Changes Changed Our Performance

Introduction: Neonatal resuscitations are challenging to any mixed ED with rotating medical staff. Covid-19 decimated nursing numbers and reduced training a standstill. New doctors nurses find pediatric (simulations in real cases) as there complex algorithms/calculations well preparing operating systems such Drager Resuscitaire R . Training or new staff for rare can be time resource consuming little yield. We describe our experience of applying incremental measures after almost every simulation improve team performance knowledge. Method: This is an ongoing audit simulations cases neonatal / infant using bay system. Our main aim was improve: 1. Nursing preparation competence for: - Pediatric drug doses system setup 2. Medical resuscitation algorithms usage (PPV/Ventilator setup) Two consultants ran “in-situ” recorded gaps/errors (including feedback debrief). Any deemed fixable were implemented ASAP. Improvement made if error not repeated subsequent two independent simulations. Results: Audits five fifteen revealed gaps (e.g. dose miscalculations, equipment unfamiliarity) which corrected by simple each discovery. These include: checklist steps the Weight-based cards pre-made packs instead manual calculations 3. Position markers "ideal" ventilator settings 4. Step step numbered on machine found improvements knowledge gaps, task accomplishment rates, satisfaction, appreciation deficits in-situ uptake. More resolved at simulation. Conclusion: A Human Factors approach adjustments led better resuscitation.