Improvement Story Seven

Lancashire Women and Newborn Centre

Contributor: Dr Amitava Sur, Dr Jasim Shihab (Consultant Neonatologists)

Challenges

Ours is a tertiary NICU in the NWODN of UK and our NICU admissions are predominantly extreme premature infants from 22 weeks onwards. Despite the intensive aspect we have foundation year trainees (FY) rotating in our unit and populating the junior rota. We have a mix of senior (ST7+) and ST4/ST5 trainees as middle grade. For the latter this is often their first posting as a middle grade and for both the foundation year trainees and the relatively junior middle grades this can be an overwhelming and often intimidating situation. Especially when it comes to preterm resuscitation the junior rota tends to feel a perceived lack of contribution to the activity as it is mostly led by consultant or senior registrar. While for the ST4/5 trainees, the relative lack of exposure and experience proves to be daunting. After feedback from trainees we addressed this using a multi-pronged approach.

Mentorship

We have identified pastoral mentors for both tiers of trainees and there are regular meetings to explore anxieties, seek and solve problems, etc. Also, all FY trainees have identified “buddys” who are either senior ANNPs or middle grade trainees through the rotation. Orientation: We have redesigned the induction program for trainees based on their feedback. While the foundation trainees have an intense 2 day induction including a NLS session run by consultants and senior staff, the induction for ST trainees have been redesigned to make it more practical. We have focussed sessions on airway management, use of delayed cord clamping trolley and umbilical access as task training sessions. This is reinforced through planned weekly MDT simulations. The aim is to instil confidence and make everyone aware of unit practice. We now ask middle grade trainees to complete part of their mandatory induction lessons as e-learning prior to induction day to maximise practical sessions. This has had great feedback.

Value and contribution

Designating defined roles to each member of team has led to more involvement and individual contribution. For example, the junior members of the team are designated “temperature champions” during preterm resuscitation. They remind the team about normothermia every 5 minutes and complete a normothermia checklist. This has led to better involvement and greater normothermia awareness. We also have a strong practice of pre-briefs and debriefs which bring the team together.