Creating the Case for Well-Newborn Care Simulation

Well-newborns are not often thought of as requiring additional support or expertise for their care. Research and literature, both medical and nursing, tend to support Labor and Delivery and Neonatal Intensive Care as opposed to the immediate postpartum period. Perhaps it is time to revisit this and build depth into these areas, including the care of the well-newborn.

Posted under: Other, Quality of Care

In 2022 and 2023, the National Perinatal Information Center partnered with GE HealthCare to explore the constellation of issues that exist within newborn falls. Many areas were identified by a nationally recognized expert team of nurse scientists, clinicians, and leaders.

Two important key measures were identified as part of this work:
  • A national framework and proposal developed to provide prevention and response guidance to quality, safety, and accrediting organizations.

  • Establish standardized, unit-specific simulation activities and drills that can be used in hospitals to promote readiness, recognition of risk, prevention of, and response to a newborn fall.
Simulation was described as an opportunity to create awareness and a safe space to facilitate in-situ opportunities for improving the quality of care for newborns. It was important to better understand the current landscape of simulation within obstetric spaces. The group performed a SWOT Analysis (Strengths, Weaknesses, Opportunities, and Threats) of overall simulation activities. Do these seem familiar to you?

Freedom to make mistakes
Safe space for failing
Build teamwork and expectations
Identify repetitive errors

Timing, time-consuming
Information overload
Availability of equipment
Availability of space
Staffing barriers
Lack of multidisciplinary commitment
Conflicting care priorities

Encourage multidisciplinary engagement
Consistent messaging
Change culture/practice
Encourage simulation with lived experience experts

Poor reputation
Budgeting constraints
Employee time
Lack of support/prioritization from providers for simulation experiences

With simulation becoming such an important factor in patient outcomes, safety, and risk reduction, how can we create opportunities out of these challenges? For organizations that continually struggle with the use of simulation (including challenges such as staffing, costs, and leadership support), what are some of the lessons learned from organizations that have embraced and enculturated simulation as a way of work? While our attention tends to focus on high-fidelity simulation, perhaps our attention needs to focus on high-quality simulation. High quality and low fidelity together can be just as effective.

There is a plethora of research and practice in the use of simulation for obstetric care, including simulations for postpartum hemorrhage, severe hypertension, sepsis, and others, including Obstetric Patient Safety (OPS, AWHONN), and Emergencies in Clinical Obstetrics (ECO, ACOG). Simulation activities are also included in programs such as Obstetric Advanced Life Support (OB ACLS), Advanced Life Support for Obstetrics (ALSO), Neonatal Resuscitation Program (NRP).

While these primarily focus on emergent events, is there an opportunity to simulate well-newborn activities that would seem to be routine, but have the potential to result in unintended harm? In some facilities, well-newborns/nursery beds are not counted in the daily census, which creates even more challenges in facilitating and supporting the costs of well-newborn simulation. While we often think of the mother/newborn dyad as a stable entity, are there potential threats that could leave a newborn exposed to a higher risk of a fall while in the hospital?

Here are just a few:

Postpartum/Well Newborn:
Bed position and bedrail management
Bassinette management and tipping risks
Unintended sleep and sleep education
Breastfeeding positions and fatigue
Cable management and ambulation
Teach-back and closed-loop communication

You will see that one of the overarching themes here is to ensure high-quality education for postpartum patients and their families. Education surrounding bassinette management, safe sleep, fatigue, and safety while ambulating are all critical for immediate postpartum patients. However, research has also shown that one of the most frequently reported missed care elements in obstetric and neonatal intensive care is that of patient education. It could be posited that patient education in well-newborn environments may be a missed care element as well, creating even more urgency for consistent and standardized care.

Most well-newborn simulation research and literature focuses on the academic setting, including the use of simulation for educational purposes before licensure, in both medical and nursing settings. Literature searches through PubMed, EBSCO, CINAHL, WorldCat, Google Scholar, and others show a dearth of information related to the use of simulation for well-newborn care in the hospital environment. Perhaps it is time to consider the use of simulation in well-newborn environments to ensure the highest quality of care.

What are some of the most important elements of well-newborn care that should be more defined? Highlighted? We’d love to hear from you.
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