BC Newborn Resuscitation Record (PSBC 1980)

1. BC Newborn Resuscitation Record(PSBC 1980) June 2019 Guide for Completion

2. Overview • Advantages of a StandardizedResuscitation Record • The Recorder • Summary of Changes • Completion of the Form • Case Study • Summary • Questions

3. Advantages of a Standardized Resuscitation Record • May assist in answering questions from family/ clinicians • Facilitates clear, concise, factual, objective, timely documentation • Information recorded can guide continuing care • Identifies staff learning needs • Provides data for research • Identifies Quality Assurance issues • Guides resource allocation(staff, supplies, equipment)

4. The Recorder • Identify the “recorder” ASAP, preferably prior to birth • Recorder should be an experienced team member witha good working knowledge of the Neonatal Resuscitation Program (NRP) Algorithm • Clinical documentation should be the recorder’s only role Responsibilities of the Recorder: • Document care provided by all health care professionals • Maintain an accurate record of the timingof all assessments and interventions • Communicate with the Team Leader and provide decision support by prompting assessments and interventions based on NRP algorithm

5. British Columbia Newborn Resuscitation Record (March 2019)

6. WHAT’S NEW? • New fields to record: • Time of cord clamping • Axillary temperature • Transfer time and location • Separate columns to record epinephrine and volume • Only one time column – recorder will decide what time source to use • Codes added to enhance standardization of documentation

7. WHAT’S NEW? • New reference tables:

8. How to complete the BC Newborn Resuscitation Record(PSBC 1980)

9. A. Demographics and Background 3 1 • Top section of record can be completed anytime during the resuscitation event, including prior to, during, or immediately after the resuscitation event 16/07/2018 14:36  14:35  36/4 2000 

10. Patient Identification 3 1 • Affix patient addressograph or label in indicated space • If not available, record patient’s Surname, Sex, and Birth Order (if multiple pregnancy) 16/07/2018 14:36  14:35  36/4 2000 

11. B. Assessments and Interventions

12. 1. TIME • Record timing of all major events (e.g., assessments and interventions) and decisions • Use a single time reference • Either actual time on a wall clock or baby’s age (in minutes) from an Apgar timer • Indicate time source by circling either ACTUAL TIME or AGE in column header • The more complex the resuscitation, the more entries should be recorded

13. 2. ASSESSMENT • This section will capture assessment information • Should be completed in real time as resuscitation event is taking place • Use codes for ease of charting and interpretation of data • Do not leave blank lines between entries • Do not squeeze entries between lines

14. RESPIRATORY EFFORT • Record respiratory effort by noting one of the following codes:  Go to #4. INTERVENTIONS, MEDICATIONS, NOTES • Record if respiratory effort is laboured(e.g., tachypnea, grunting, retractions)

15. HEART RATE • [Top-left] Record heart rate • [Bottom-right] Record method by which heart rate was obtained by noting one of the following codes: • If the baby has a low heart rate or poor perfusion, a pulse oximeter is not a recommended method for measuring the heart rate • Palpation of the cord is not a recommended method to measure the heart rate A = Auscultation Ox = Pulse oximeter E = Electrocardiography (ECG) 120 A 143 Ox 146 E

16. O2 SATURATION • Record the preductal (right hand or wrist) oxygen saturation as per the pulse oximeter • Compare oxygen saturation with target saturations   Alert team leader if there is a needto administer additional oxygen to meet target saturations Note: Target pre-ductal saturation values are only applicable in the immediate newborn period; After one hour of birth oxygen saturation should be ≥ 95% 63

17. COLOUR • Record colour of the baby by noting one of the following codes:

18. TONE • Record tone of the baby by noting one of the following codes:

19. 3. INTERVENTIONS • This section will capture intervention information • Should be completed in real time as resuscitation event is taking place • Use codes for ease of charting and interpretation of data • Ensure that time stamp correlates with assessment and intervention

20. Ventilation Device • Specify the ventilation device used by selecting one of the following: • T-piece • Self-inflating • Flow-inflating  Go to #4. INTERVENTIONS,MEDICATIONS, NOTES • Record if device was changed during the resuscitation and reason for the change

21. O2 % ON BLENDER • Record amount of oxygen delivered as per air/oxygen blender • This will include Positive Pressure Ventilation (PPV), Continuous Positive Airway Pressure (CPAP) or free-flow oxygen administration

22. VENTILATION RATE • Record number of administered breaths per minute

23. PPV OR CPAP • If Positive Pressure Ventilation (PPV) used: • [Top-left]Record Peak Inspiratory Pressure (PIP) • [Bottom-right] Record Positive End-Expiratory Pressure (PEEP) • If Continuous Positive Airway Pressure (CPAP) used: • [Top-left] *leave blank* • [Bottom-right] Record pressure 20 5 5

24. Interface Device • Record interface device used by noting one of the following codes:

25. Interface Device  Go to #4. INTERVENTIONS, MEDICATIONS, NOTES • If ETT or LMA used, document the following: • Whether insertion was successful/ unsuccessful • Name of person who performed procedure • Number of attempts • ETT/ LMA size • Insertion depth (for ETT) • Confirmation method • Timing of procedure (should be ≤ 30 seconds)

26. CHEST COMPRESSIONS • [Top-left] Indicate whether chest compressions were administered by noting ‘✓’ if they were • [Bottom-right] Indicate whether oxygen was turned up to 100% by noting ‘✓’ if it was  Alert team leader if oxygen has not been turned up to 100% ✓ ✓

27. EPINEPHRINE • Indicate whether epinephrine was administered by noting ‘✓’ if it was  Go to #4. INTERVENTIONS, MEDICATIONS, NOTES • If epinephrine administered, document the following: • Concentration • Dose • Route • Prescriber • Effect

28. VOLUME • Record type of volume administered by noting one of the following codes:

29. VOLUME  Go to #4. INTERVENTIONS, MEDICATIONS, NOTES • If volume administered, document the following: • Dose • Route • Prescriber • Effect

30. 4. INTERVENTIONS, MEDICATIONS, NOTES

31. 4. INTERVENTIONS, MEDICATIONS, NOTES • If resuscitation occurred at birth, specify the following in first entry: • Mode of delivery • Number of babies delivered (multiple gestation) • Information about pertinent delivery complications

32. 4. INTERVENTIONS, MEDICATIONS, NOTES • Record other important information pertaining to resuscitation event that was not captured in previous sections, including: • Name of person who performed invasive interventions • Baby’s response to interventions performed • Type of suctioning performed (i.e., oropharyngeal or tracheal) and type/ amount of secretions (e.g., meconium, mucus, etc.) • Umbilical Venous Catheter (UVC) size, insertion depth, confirmation method, and name of person who inserted it • Procedures or diagnostic tests performed, including volume of blood taken for test, and results (if available/ reported) • Time of arrival and designation of additional health care providers who present to resuscitation event • Baby’s condition post-resuscitation • How baby was transported post-resuscitation

33. Temperature & Transfer Information

34. Temperature & Transfer Information • Record baby’s axillary temperature at end of resuscitation or at 10 minutes, whichever is first • Record time when baby’s axillary temperature was assessed  Go to #4. INTERVENTIONS, MEDICATIONS, NOTES • If a servo temperature probe applied to the baby, record temperature at 5 minute intervals

35. Temperature & Transfer Information • Record time when the baby was transferred from initial location where resuscitation took place • Record location to which the baby was transferred to at end of resuscitation

36. 5. ADDITIONAL NARRATIVE NOTES (Page 2) • Following the neonatal resuscitation, record a retrospective narrative summary of event to supplement real-time documentation of assessments and interventions (Sections 1-4)

37. C. Sign-Offs • This section identifies all those present at the resuscitation event, including the Recorder • Should be completed after resuscitation event • The recorder and all other personnel present must print, sign, initial and indicate their profession in the designated fields • A signature indicates that the individual has read and is in agreement with everything as it is documented on the Newborn Resuscitation Record • The recorder’s information should be specified in the first entry

38. CASE STUDY

39. Case Study You are asked to be the recorder at the vaginal delivery of a 41 + 5 week baby. The mother is 31 years old, G 1 P 1. Induction of labour has been started 10 hours ago. Membranes ruptured spontaneously 3 hours ago. The fetal heart tracing is atypical and the amniotic fluid now shows some thick meconium staining.

40. Case Study • After collecting a copy of the Newborn Resuscitation Record, a clipboard and a pen, you position yourself where you are able to see and hear everything the team will do in the event of a resuscitation. • While the team is preparing for the imminent birth you have time to complete some parts of Section A: Demographics and Background of the Newborn Resuscitation Record: 1 Baby Doe 13/02/2019 Since the addressograph will not be available until after the birth of the baby you document the baby’s surname (maternal surname).  40/5 SVD, atypical fetal tracing, thick meconium present.

41. 30 Seconds • The baby is born at 14:35. • The team announces that it is a boy. • Baby appears apneic and limp, so the team dries and stimulates the baby. • At 30 seconds the baby is still apneic and limp, the cord is clamped and cut, and the baby is brought over to the warmer. 1 Baby Doe 13/02/2019 Male  14:35  40/5 SVD, atypical fetal tracing, thick meconium present. Ø Baby dried and stimulated. H 15sec Ø Cord cut at 30 sec and baby brought to warmer. 30sec H

42. 45 Seconds • The baby is still apneic and limp,so at 45 seconds PPV is initiated. • The team uses a T-piece • You observe the following: • The baby is receiving a breath every second. • The blender is at room air. • The PIP and PEEP on the manometer. • and a facemask. 1 Baby Doe 13/02/2019 Male  14:35  40/5  SVD, atypical fetal tracing, thick meconium present. Ø Baby dried and stimulated. H 15sec Ø Cord cut at 30 sec and baby brought to warmer. 30sec H 45sec Ø H 21 60 20 M 5

43. 1 Minute • At 1-minute the assessment is as follows: • Poor air entry and no chest rise. • Heart rate counted as 7 beats in 6 seconds. • The team starts corrective measures to achieveeffective ventilation (MRSOPPA). • The oxygen on the blender, ventilation rate and pressures remain unchanged. • Baby is still apneic and limp, and pale in appearance. 1 1 Baby Doe 13/02/2019 Male  14:35  40/5  SVD, atypical fetal tracing, thick meconium present. Ø Baby dried and stimulated. H 15sec Ø Cord cut at 30 sec and baby brought to warmer. 30sec H 45sec Ø H 21 60 20 M 5 70 20 M M H 21 Ø 60 1 Team starts MRSOPPA - MR. Poor air entry and no chest rise. A 5

44. 1 Minute 20 Seconds • At 1-minute 20-seconds the assessment is as follows: • Poor air entry and some chest rise. • Heart rate counted as 7 beats in 6 seconds. • The rest of the parameters remain the same. • Team moves to SO of MRSOPPA: • Thick mucus and meconium removed from airway when suctioned. 1 1 Baby Doe 13/02/2019 Male  14:35  40/5  SVD, atypical fetal tracing, thick meconium present. Ø Baby dried and stimulated. H 15sec Ø Cord cut at 30 sec and baby brought to warmer. 30sec H 45sec Ø H 21 60 20 M 5 70 20 M M H 21 Ø 60 1 Team starts MRSOPPA - MR. Poor air entry and no chest rise. A 5 70 20 1:20 Ø M H 21 60 M Poor air entry, some chest rise. SO - suction, thick mucus, mec. A 5

45. 1 Minute 30 Seconds • At 1-minute 30-seconds the oxygen saturation probe is applied,connected to the oxygen saturation measurement device, andswitched on. • Machine not reading SpO2yet. • The rest of the parameters remain the same. 1 1 Baby Doe 13/02/2019 Male  14:35  40/5  SVD, atypical fetal tracing, thick meconium present. Ø Baby dried and stimulated. H 15sec Ø Cord cut at 30 sec and baby brought to warmer. 30sec H 45sec Ø H 21 60 20 M 5 70 20 M M H 21 Ø 60 1 Team starts MRSOPPA - MR. Poor air entry and no chest rise. A 5 70 20 1:20 Ø M H 21 60 M Poor air entry, some chest rise. SO - suction, thick mucus, mec. A 5 20 70 1:30 Ø M H 21 60 M Sat probe on , not picking up. 5 A

46. 1 Minute 40 Seconds • At 1-minute 40-seconds the team reports that the baby is making respiratory efforts. • Air entry has improved, there is chest rise, and the heart rate is 9 beats in 6 seconds. • The ventilation rate is decreased to 40 breaths per minute. • The team reports that the baby’s tone is improving. • You notice that the O2saturation is 58% • The team leader orders oxygen to be increased to 30%. • No change in other parameters. • You notice that the O2 saturation is 58%, so you alert the team leader to consider administering additional oxygen to meet target saturations. 1 1 Baby Doe 13/02/2019 Male  14:35  40/5  [Previous entries omitted from view.] 90 20 1:40 M SF 30 40 M 58 Baby starting to make some respiratory efforts. 5 A

47. 2 Minutes • and the heart rate is 120 bpm. • At 2-minutes the baby is breathing spontaneously. • On the pulse oximeter you notice that the SpO2 is 65 • Good air entry is confirmed with auscultation. • The provider also confirms that the auscultated heart rate matches the rate displayed on the pulse oximeter. • The team decides to stop ventilating and provides free-flow oxygen. • No other changes are reported or noted. 1 1 Baby Doe 13/02/2019 Male  14:35  40/5  [Previous entries omitted from view.] 90 20 1:40 M 30 40 M 58 SF Baby starting to make some respiratory efforts. 5 A 120 2  65 M SF 30 M HR on auscultation matches rate on pulse oximeter. Ox

48. 2 Minutes 30 Seconds • At 2-minutes 30-seconds the assessment is as follows: • The baby is breathing well. • Heart rate is 140bpm. • SpO2is 78. • The baby’s colour and tone have improved. • The NRP Team Leader decides to discontinue supplemental oxygen as infant is meeting target pre-ductal saturation for age in minutes. 1 1 Baby Doe 13/02/2019 Male  14:35  40/5  [Previous entries omitted from view.] 90 20 1:40 M 30 40 M 58 SF Baby starting to make some respiratory efforts. 5 A 120 2  65 M SF 30 M HR on auscultation matches rate on pulse oximeter. Ox 140 2:30  78 P  Ox

49. Completion of Newborn Resuscitation Record 1 1 1 • Complete: • End of Section B • Section C • Page # section Baby Doe 13/02/2019 Male  14:35  40/5  SVD, atypical fetal tracing, thick meconium present. Ø Baby dried and stimulated. H 15sec Ø Cord cut at 30 sec and baby brought to warmer. 30sec H 20 45sec Ø H 21 60 M 5 70 20 M M H 21 Ø 60 1 Team starts MRSOPPA - MR. Poor air entry and no chest rise. 5 A 70 20 1:20 Ø M H 21 60 M Poor air entry, some chest rise. SO - suction, thick mucus, mec. A 5 70 20 1:30 Ø M H 21 60 M Sat probe on , not picking up. A 5 90 20 1:40 M 30 40 M 58 SF Baby starting to make some respiratory efforts. 5 A 120 M 2  65 SF 30 M HR on auscultation matches rate on pulse oximeter. Ox 140 2:30  78 P  Ox MD Best Recorder RN Dr. Very Nice 36.8 14:42 Best Recorder BR VN RT Breath RT Breath RTB RT

50. Add to Patient Record 1 1 1 Baby Doe 13/02/2019 Male  14:35  40/5  SVD, atypical fetal tracing, thick meconium present. Ø Baby dried and stimulated. H 15sec Ø Cord cut at 30 sec and baby brought to warmer. 30sec H 20 45sec Ø H 21 60 M 5 70 20 M M H 21 Ø 60 1 Team starts MRSOPPA - MR. Poor air entry and no chest rise. A 5 70 20 1:20 Ø M H 21 60 M Poor air entry, some chest rise. SO - suction, thick mucus, mec. A 5 70 20 1:30 Ø M H 21 60 M Sat probe on , not picking up. A 5 90 20 1:40 M 30 40 M 58 SF Baby starting to make some respiratory efforts. 5 A 120 M 2  65 SF 30 M HR on auscultation matches rate on pulse oximeter. Ox 140 2:30  78 P  Ox MD Best Recorder RN Dr. Very Nice 36.8 14:42 Best Recorder BR VN RT Breath RT Breath RTB RT