Policy/ Procedure POLICY PROCEDURE. TITLE: Contacting the Neonatal Resuscitation Team Effective Date: May 1 st, 2015 NUMBER: 1420.

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1 Policy/ Procedure TITLE: Contacting the Neonatal Resuscitation Team Effective Date: May 1 st, 2015 NUMBER: 1420 Page(s): 1 of 9 Applies To: All IWK Health Centre staff POLICY Infants requiring resuscitation may be identified at various stages: antenatally, in the birthing room, or during the neonatal period. This document outlines the process for when and how to contact the Neonatal Team for resuscitation of neonates at the IWK Health Centre. The Neonatal Team will be contacted for high risk births within the IWK Health Centre, as well as for other neonatal emergencies of neonates in the Women s and Newborn Health Program. The Neonatal Team may also be contacted for any imminent births outside of the Birth Unit as outlined in the IWK Health Centre Code Blue Response Policy #704. The Neonatal Team will be contacted for neonates admitted to the Women s and Newborn Health Program, who require neonatal resuscitation while in other areas of the Health Centre (e.g. Radiology Department). Neonatal Team members (Beta and Alpha team members) will have current Neonatal Resuscitation Program (NRP) registration, and will be assigned each shift to carry emergency pagers. The members (RN, RRT, Senior NNP/Physician) of the Neonatal Team designated as Alpha/Beta teams will each carry a pager. Alpha/ Beta teams may also include one other learner (i.e. new staff members, Residents, Clinical Associates, etc.) who will also carry a pager as determined by the Neonatal Team (See Definitions in Appendix A) PROCEDURE The Birth Unit Team Leader and E Nurse will communicate on a regular basis to identify births that would require the Alpha or Beta Team. Communication with the Neonatal Team liaison or designate should occur as soon as an issue is identified and a plan of contact for the birth should be verbalized and documented in the patient s health record and communicated to the patient/family. This should be updated as assessments change.

2 Contacting the Neonatal Resuscitation Team Page 2 of 9 The Neonatal Team should be paged by using the hospital paging system according to the level of resuscitation needed. If additional medical assistance is required for either the Alpha or Beta team the Neonatologist may be requested and must be paged separately. The Neonatal Team is responsible for the resuscitation according to NRP standards unless otherwise directed by a neonatologist. If the Neonatal Team is present for an anticipated resuscitation and following birth the infant is vigorous and does not require resuscitation the Neonatal Team in collaboration with the obstetrical care team can then leave without an assessment. This will facilitate skin to skin for the baby and mom. GUIDELINES Indications for Calling the Neonatal Team The Neonatal Team is designated into Alpha and Beta designations and is based on level of resuscitation required as outlined by criteria setup in this document. Alpha Team (page 1375) The Alpha team will be contacted for moderate risk deliveries in the BU. Indications for paging the Alpha Team may include but not limited to: weeks gestation Intrauterine growth restriction with estimated fetal weight less than 2500 g Rh immunized baby without hydrops or severe anemia Atypical/abnormal fetal heart rate tracing leading to intervention Amniotic fluid with meconium staining As otherwise determined by obstetrician/ family physician/midwife Birth Unit Team. Beta Team (Page 1375 (Alpha) ) The Beta team will be contacted for high risk deliveries in the Birth Unit. Indications for paging the Beta team may include but is not limited to the following: Less than 32 weeks gestation Shoulder dystocia Multiple births (usually one team for each baby dependent upon gestational age) Congenital anomalies requiring immediate care (e.g. gastroschisis, cyanotic heart disease) Rh immunization with hydrops or severe anemia Possible fetal compromise/emergency caesarian section (e.g. abruption, prolapsed cord) Maternal infusion of Magnesium sulfate for greater than 48 hrs As otherwise determined by obstetrician/birth Unit/ Midwife/ Neonatal Team. The Beta Team will also respond to other emergent requests for neonatal resuscitation throughout the Health Centre.

3 Contacting the Neonatal Resuscitation Team Page 3 of 9 Special Considerations for Multiple Gestation Deliveries: Call the Beta Team (Alpha pager 1375 & senior clinician pager 1921) first and Alpha 2 (pager #1834) Team. Additional Indications/Special Considerations for Contacting the Neonatal Team AFTER Delivery: If, after birth, the baby requires resuscitation or urgent assessment, page the Beta Team and notify the newborn s primary care provider If, after delivery, the baby requires a non-urgent assessment, the unit nursing staff will notify the newborn s primary care provider to assess the baby and determine if a consultation is required. If a consult is requested the newborn physician will contact the neonatologist or NNP/CA/resident to arrange for an assessment. PROTOCOL Activation of the Neonatal Team: The Neonatal Team should be paged by using the hospital paging system according to the level of resuscitation needed i.e. Alpha or Beta teams. For non urgent, non stat calls the team required can be paged directly a. Alpha Team RN & RRT ( pager 1375) b. Beta team (alpha pager 1375 ) and senior clinician pager 1921 For STAT calls use 3333 which will also activate the Overhead paging system. i. Dial 3333 (if calling from a patient room dial ) ii. Ask for the Neonatal Team and specify location (i.e. room or OR# ) where the team is required. This will activate the Beta Team. Switchboard Operator The Switchboard operator responds to the #3333 STAT call by using the following procedure: Dial the Beta team (alpha pager 1375 ) and senior clinician (pager 1921) The emergency pagers will respond with a fast beeping sound Use the voice page and say, Neonatal Team to (Specific Location) STAT. Repeat this statement three times Activate the Public Address System and announce the same information as above (iii). Repeat the statement three times. Neonatal Resuscitation Team Duties The E Nurse acts as a liaison between the Neonatal Intensive Care Unit and the Birth Unit. Regular nursing rounds are made to the Birth Unit to obtain information regarding potential highrisk deliveries. Information about pending deliveries is also communicated by telephone.

4 Contacting the Neonatal Resuscitation Team Page 4 of 9 The information is written on the E Nurse report sheet (electronic generated whiteboard census) or equivalent downtime document, and placed in a binder in Neonatal Intensive Care Unit 1. Information is also provided verbally during report, throughout the shift and sign out rounds. Notify a Neonatologist/Neonatology Fellow, who will determine who needs to be present at the delivery in the following situations: a. Less than 28 weeks gestation b. Major congenital anomalies requiring immediate care (e.g. diaphragmatic hernia, airway anomaly, hydrops) c. As otherwise arranged with obstetrical team (in consultation with the mother s physician) d. Multiple gestations greater than twins i.e. triplets, quadruplets e. As otherwise requested by the Beta Team Neonatal Resuscitation Equipment All Neonatal Resuscitation Carts (Red) and Neonatal Resuscitation Boxes (Black) will be sealed with a red plastic clip. a. The E Nurse: Checks the Neonatal Emergency carts (Red) and Neonatal Resuscitation Boxes (Black) as per pre-set schedule of dates for checking carts and boxes. Dates are indicated on the audit form for checking the carts. Ensures the boxes and carts are sealed, view the expiry date checklist and replace any necessary supplies. Signs the daily Emergency Cart audit form kept in the E Nurse binder located at the nursing station to verify that the equipment was checked. b. If the cart or box is unsealed or has been used, a member of the Neonatal Team checks the contents against the cart or box supply list and reseals it. c. For deliveries and/or Neonatal Emergencies in other areas of the Health Centre, the E Nurse carries a bag with resuscitation medications, syringes, laryngoscope and blade. The medication bag is located on the crash cart in NICU 1 and in a red bin behind the nursing desk in NICU 2 (See Appendix A for a list of contents) Location of Neonatal Resuscitation Equipment a. For emergencies within the Birth Unit, Emergency Carts (Red) are located in the following areas: i. Outside the Operating Room door ii. Outside Room #4 iii. Outside Room #7 iv. Outside Room #10 v. Outside Room #13 b. A Neonatal Resuscitation Box (Black) is located in the following areas. (See Appendix A): i. Prenatal Special Care Unit (7A) Located on the overhead warmer

5 Contacting the Neonatal Resuscitation Team Page 5 of 9 REFERENCES ii. Family Newborn Unit (5A) next to overhead warmer in Extra Care Area iii. Family Newborn Unit (5B) next to overhead warmer in Observation Area iv. With the emergency incubator located outside the Early Labour Assessment Unit (ELAU) v. With the emergency incubator located outside the Admitting Department, Women s and Maternity Services Site Vi.Outside the Emergency Department Trauma Room American Academy of Pediatrics and American Heart Association (2011). Textbook of neonatal resuscitation, 6th ed. (Eds): Author.. American Heart Association (2010). Part 11: Neonatal Resuscitation: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Circulation, 122: S516-S538. Doi: /CIRCULATION/AHA Canadian NRP Steering Committee (2011) Addendum to the NRP Provider Textbook 6th Edition: Recommendations for specific modifications in the Canadian context retrieved from Finan, E. Alyward, K. & Aziz, K. (2011). Neonatal resuscitation guidleines update: A case based review. Pediatric Childrens Health, 16(5), , Retrieved on January 27 th, 2015 from Thomas, E.J., Sexton, J.B., Lasky, R.E., Helmreich, R.L., Crandell, D.S. & Tyson, J. (2006). Teamwork and quality during neonatal care in the delivery room. Journal of Perinatology, 26, RELATED DOCUMENTS Policies IWK Health Centre Policy #704 Code Blue Response for Medical &/or Obstetrical Emergencies for Patients, Staff and Visitors IWK Health Centre Policy Medication Management Policy #3.28 Emergency Drug trays/kits/boxes Centre Wide Appendices Appendix A: Definitions Appendix B: Neonatal Resuscitation Equipment

6 Contacting the Neonatal Resuscitation Team Page 6 of 9 APPENDIX A DEFINITIONS The Neonatal Resuscitation Team (Neonatal Team) is a coordinated team of health care providers trained to assess, and if required, intervene with infants at high risk who may require resuscitation at delivery and during the neonatal period. The team is further subdivided into Alpha team and Beta team. The Alpha Team comprised of: 1. Neonatal Registered Nurse (RN) or E Nurse 2. Registered Respiratory Therapist (RRT) There will be 2 Alpha teams assigned each shift and designated as Alpha (pager 1375) and Alpha 2 (pager 1834) (second team). The Beta Team is comprised of (Alpha team and medical person): 1. Neonatal Registered Nurse (RN) or E Nurse 2. Registered Respiratory Therapist (RRT) 3. Neonatal Nurse Practitioner (NNP) or Physician (Senior Pediatric Resident or Clinical Associate (CA)) or Neonatal fellow.

7 Contacting the Neonatal Resuscitation Team Page 7 of 9 Appendix B Neonatal Resuscitation Equipment Located in Women s Site Lobby, ELAU, FNASU, and PSCU NEONATAL BLACK RESUSCITATION BOX TOP TRAY White tape, 1/2 inch 1 Meconium Aspirators 2 Lg Plastic Bag 1 Pen 1 Scissors 1 Bulb Syringe 1 Cord Clamps 2 Stethoscope 1 BOTTOM TRAY Endotracheal Tubes: 2.5,3.0,3.5 2 each Stylets 2 Pedicap 1 DeLee Suction 1 Emergency Pneumothorax Kit 1 Feeding tube # ml Oral Syringe 1 Umbilical Catheter Pack 1 Catheters: 2.5,3.5,5 Sterile Gloves, size 6, 6.5,7,7.5,8 Cardiac Arrest Record 1 INSIDE INCUBATOR (Lobby & ELAU)/Overbed Warmer (FNASU & PSCU) Laerdal bag 1 MIE 1 Masks, size 0,1,2 O2 Tank 1 O2 Tubing 1 Suction Catheters, size 8 & 10 2 each Portable Suction 1 Umbilical Catheter Tray 1

8 Contacting the Neonatal Resuscitation Team Page 8 of 9 Appendix B (continued) Neonatal Resuscitation Equipment Trauma Room Emergency Department Children s Site NEONATAL BLACK RESUSCITATION BOX TRAUMA ROOM Cord Clamps 2 White tape 1/2 inch 1 Lg Plastic Bag 1 Pen 1 Scissors 1 Bulb syringe 1 Endotracheal tubes, 2.5,3,3.5 2 each Stylet 2 Pedicap 1 Meconium Aspirators 2 Laerdal bag 1 Masks, size 0,1,2 size O2 Tubing 1 Pneumothorax kit 1 DeLee Suction 1 Feeding tube # ml Oral Syringe 1 Umbilical Catheter Pack 1 Catheter Tray 1 Catheters 2.5,3.5,5 Cardiac Arrest Record 1

9 Contacting the Neonatal Resuscitation Team Page 9 of 9 Appendix B (continued) Neonatal Resuscitation Equipment Neonatal Team Emergency Bag NEONATAL EMERGENCY BAG Alcohol & Chlorohexidine Swabs Cotton balls Medication Labels Pen 1 Lg Plastic Bag Medications: Prefilled Saline Syringes 4 Prefilled Bicarbonate Syringes 1 Prefilled Epinephrine Syringes 2 Naloxone Vials 2 Needles: 27G and blunt filtered 5 each Syringes: 1 ml & 3 ml 3 each Syringes: 30 ml & 60 ml Batteries for laryngoscope 2 Laryngoscope 1 Laryngoscope blades: # 0 & 1 Oral Airways: #000 2 #00 2 #0 1