Determination of the adherence of nurses to national neonatal resuscitation guidelines at Pumwani maternity

Abstract

Background and significance: MDG4 targets a reduction in the Under 5 year Mortality Rate (U5MR) by two thirds between 1990 and 2015 and it has been noted that neonatal deaths are becoming a greater portion of the total under 5 mortalities. Globally, 3-6% of neonates require basic resuscitation and it has been demonstrated that basic resuscitation of newborn babies can lead to a 6-42% decrease in neonatal deaths. Kenya as a country has developed guidelines on neonatal resuscitation in an attempt to save as many neonates as possible. Our aim was to assess if these protocols were indeed correctly being put into practise at Pumwani Maternity Hospital (PMH). Objectives: Our primary objective was to determine the level of adherence of nurses to the National neonatal resuscitation guidelines at PMH. Methodology: We carried out a cross sectional survey at PMH over a period of three months. This involved determining the availability of basic equipment required for neonatal resuscitation at PMH as well as an analysis of the knowledge and practices of the nurses of neonatal resuscitation. Results: Of the 140 resuscitations observed in three locations at PMH (labour ward, maternity theatre and newborn unit), the National guidelines were only adhered to in 39%. Three quarter of the resuscitations were observed during the day while the remainder were observed at night. When analysed according to the different steps of resuscitation, the guidelines were adhered to in 71.4% of the resuscitations in preparation, drying and warming, 63.6% in airway and 39.3% in breathing. The most poorly performed steps were correct suctioning in the presence of meconium (52.5%), calling for help (67.1%), giving the correct number of inflation breaths (56.4%) and achieving adequate chest rise during ventilation (73.5%). Adherence to guidelines was better in the new born unit (OR 3.75, p=<0.001), when all resuscitation equipment was available (OR 2.74, p=0.004), in cases of resuscitation of preterm neonates (OR 0.18, p=<0.001) and neonates less than 2500 grams (OR 0.37, p=0.008). Resuscitation equipment was fully available in 57% of the resuscitations with the shortage of two dry towels for each resuscitation being the major gap. Only 57.1% of the 35 nurses attained ≥50% on the knowledge assessment. Knowledge was poorest in the following areas: identifying preparation as the most important step in resuscitation, correct number of inflation and ventilation breaths, knowing when to initiate chest compressions, use of oxygen in resuscitation and the frequency of assessing the neonate during resuscitation. Conclusion: Of the 35 nurses observed 5.7% adhered to the National guidelines with 39% of the 140 resuscitations being carried out well.