| Maintaining high levels of readiness for neonatal resuscitation in settings with low-risk maternity services is challenging. Use of the American Academy of Pediatrics (NRP) algorithm is a community standard in the United States, yet training is often only required every 2 years, and few staff receive enough exposure to these critical events, either in training or practice, to be proficient at timely implementation of the algorithm and the advanced procedures such as umbilical vein access and endotracheal intubation. The average Neonatal Resuscitation Index (knowledge) score is low, and confidence is lost in the ability to perform NRP. Evidence supports the value of hands-free leadership to help prevent task saturation and the benefits of communication to promote patient safety. The conceptual framework guiding this study is that visibility, respect, and communication nourish clinical practitioners. A practice proposal was developed for the use of telemedicine during neonatal resuscitation that involves the addition of a remote, expert NRP leader in the form of a NICU-based neonatal nurse practitioner or neonatologist via telemedicine technology to augment the effectiveness of the low-risk birth center team. This practice proposal provides policy and practice guidelines developed after review of the evidence-based literature, an implementation plan, and an evaluation plan utilizing debriefing and chart review. Literature review topics included newborn resuscitation, NICU, NRP, patient safety, teamwork, communication, and telemedicine. Selection was based on relevance to the use of telemedicine for neonatal patient care, teamwork and communication, and neonatal resuscitation. The positive social impact of telemedicine NRP leadership could improve medical care in remote and low resource birthing centers throughout the United States, as well as around the world. |
