title: Impact of a novel decision support tool on adherence to Neonatal Resuscitation Program algorithm.
abstract: OBJECTIVE
  Studies have shown that healthcare professionals (HCPs) display a 16-55% error rate in adherence to the Neonatal Resuscitation Program (NRP) algorithm. The aim of this study was to evaluate adherence to the Neonatal Resuscitation Program algorithm by subjects working from memory as compared to subjects using a decision support tool that provides auditory and visual prompts to guide implementation of the Neonatal Resuscitation Program algorithm during simulated neonatal resuscitation.
  
  
  METHODS
  Healthcare professionals (physicians, nurse practitioners, obstetrical/neonatal nurses) with a current NRP card were randomized to the control or intervention group and performed three simulated neonatal resuscitations. The scenarios were evaluated for the initiation and cessation of positive pressure ventilation (PPV) and chest compressions (CC), as well as the frequency of FiO2 adjustment. The Wilcoxon rank sum test was used to compare a score measuring the adherence of the control and intervention groups to the Neonatal Resuscitation Program algorithm.
  
  
  RESULTS
  Sixty-five healthcare professionals were recruited and randomized to the control or intervention group. Positive pressure ventilation was performed correctly 55-80% of the time in the control group vs. 94-95% in the intervention group across all three scenarios (p<0.0001). Chest compressions were performed correctly 71-81% of the time in the control group vs. 82-93% in the intervention group in the two scenarios in which they were indicated (p<0.0001). FiO2 was addressed three times more frequently in the intervention group compared to the control group (p<0.001).
  
  
  CONCLUSIONS
  Healthcare professionals using a decision support tool exhibit significantly fewer deviations from the Neonatal Resuscitation Program algorithm compared to those working from memory alone during simulated neonatal resuscitation.
authors.affiliation: Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, United States. Electronic address: jfuerch@stanford.edu.
authors.forename: Janene H
authors.initials: JH
authors.lastname: Fuerch
authors.affiliation: Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, United States.
authors.forename: Nicole K
authors.initials: NK
authors.lastname: Yamada
authors.affiliation: MedicalCue(®), Mountain View, CA, United States.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Coelho
authors.affiliation: Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, United States.
authors.forename: Henry C
authors.initials: HC
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, United States.
authors.forename: Louis P
authors.initials: LP
authors.lastname: Halamek
mesh_terms: D000328:Adult; D000465:Algorithms; D002983:Clinical Competence; D003661:Decision Support Techniques; D004501:Education, Medical / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010348:Patient Care Team / Q000592:standards*; D011446:Prospective Studies; D012151:Resuscitation / Q000193:education*
keywords: Decision support tool; Neonatal Resuscitation Program; Simulation