Effect of a positive pressure ventilation-refresher program on ventilation skill performance during simulated newborn resuscitation

AIM: Clinical staff highly proficient in neonatal resuscitation are essential to ensure prompt, effective positive pressure ventilation (PPV) for infants that do not breathe spontaneously after birth. However, it is well-documented that resuscitation competency is transient after standard training. We hypothesized that brief, repeated PPV psychomotor skill refresher training would improve PPV performance for newborn care nurses. METHODS: Subjects completed a blinded baseline and post PPV-skills assessment. Data on volume and rate for each ventilation was recorded. After baseline assessment, subjects completed PPV-Refreshers over 3 months consisting of psychomotor skill training using a newborn manikin with visual feedback. Subjects provided PPV until they could deliver ≥30 s of PPV meeting targets for volume (10−21 mL) and rate (40–60 ventilations per minute [vpm]). Baseline and post assessments were compared for total number PPV delivered, number target PPV delivered (volume 10−21 mL), mean volume and mean rate (Wilcoxon signed-rank test, median[IQR]). RESULTS: Twenty-six subjects were enrolled and completed a baseline assessment; 24 (92%) completed a post-assessment; 2 (8%) were lost to follow-up. Over 3 months, a mean 3.2 (range 1–6) PPV-Refreshers/subject were completed. Compared to baseline, subjects demonstrated significant improvement for total (57 [36–74] vs. 33 [26–46]; p = 0.0007) and target PPV (23 [13–23] vs. 11 [5–21]; p = 0.024), and a significant change in mean volume (mL) (11.5 [10.2–13] vs. 13.4 [11–16]; p = 0.02) and mean rate (vpm) (54 [45–61] vs. 40 [28–49]; p = 0.019). CONCLUSIONS: A PPV-Refresher program with brief, repeated psychomotor skill practice significantly improved PPV performance with the greatest improvement in total PPV and target PPV. Additional investigation is warranted to determine optimal PPV-Refresher frequency. Registered at ClinicalTrials.gov #NCT02347241