The most common patient safety issues resulting in legal action against neonatologists

State-of-the art training in neonatal resuscitation

Healthcare training has traditionally emphasized acquisition and recall of vast amounts of content knowledge; however, delivering care during resuscitation of neonates requires much more than content knowledge. As the science of resuscitation has progressed, so have the methodologies and technologies used to train healthcare professionals in the cognitive, technical and behavioral skills necessary for effective resuscitation. Simulation of clinical scenarios, debriefing, virtual reality, augmented reality and audiovisual recordings of resuscitations of human neonates are increasingly being used in an effort to improve human and system performance during this life-saving intervention. In the same manner, as evidence has accumulated to support the guidelines for neonatal resuscitation so, too, has affirmation of training methodologies and technologies. This guarantees that training in neonatal resuscitation will continue to evolve to meet the needs of healthcare professionals charged with caring for newborns at one of the most vulnerable times in their lives.

"We're All Time Poor": Experienced Clinicians' and Students' Perceptions of Challenges Related to Patient Communication

PHENOMENON

Communication is a complex and essential element of clinical practice. It is widely accepted that communication skills can be taught and learned, but challenges remain for clinicians in achieving effective communication with patients. This study explored the patient-communication challenges faced by both medical students and experienced clinicians.

APPROACH

Semi-structured interviews were conducted with twenty medical students and nineteen experienced clinicians from a range of medical disciplines. Interviews were recorded and transcribed, and transcriptions subjected to thematic analysis and coding to quantify the challenges discussed.

FINDINGS

There was remarkable consistency in the challenges described by both groups of participants, with eight predominant challenges identified: time constraints and chaotic environments, rapport building, patient characteristics, reluctance, omissions, assumptions, decision-making, and keeping conversations focused.

INSIGHTS

Medical curricula often focus on communication challenges associated with complex or sensitive clinical situations, but many of the challenges identified occur in routine consultations. Both pre-service and post-graduate medical training should adopt strategies to help build students' and clinicians' skills in managing these challenges from the outset of training.

Systematic review of medical literature for medicolegal claims and complaints involving neonates

IMPORTANCE

Complaints and malpractice claims by families on the care of their babies are pertinent issue. Beyond just the financial implications, it involves harm to babies and distress to parents.

OBJECTIVE

The aim was to review published reports of complaints by families on the care of their babies in the neonatal units in order to understand the nature of these complaints and the areas of care that they relate to.

METHODS

We considered articles in English, which report on complaints made by families to organisations providing neonatal care. We performed our structured search on AMED, CINAHL, EMBASE, EMCARE, SCOPUS and MEDLINE from January 2000 to December 2020. A total of 378 articles were appraised using eligibility criteria.

RESULTS

A total of 12 articles were included. The most common category of complaint was delayed/incorrect diagnosis. Communication issues were highlighted as a significant category of complaints. The majority of such claims were between the physicians and families. Factors implicated for clinician's errors that resulted in complaints were lack of clinical and communication training, inadequate supervision of junior clinicians, work culture and hierarchy, not listening to families' concerns and system failure.

CONCLUSIONS

The most frequent categories of complaint reported in our systematic review were delayed/incorrect diagnosis and delayed/incorrect treatment. Organisations should be encouraged to share complaints data as it can facilitate shared learning. An understanding of human factor principles and its role in patient safety is also emphasised in this report in order to optimise patient outcomes and improve experience for families requiring neonatal care.

Neonatal Hypoglycaemia: A Never-Ending Story?

Neonatal hypoglycaemia is a common metabolic disorder presenting in the first days of life and one potentially preventable cause of brain injury. However, a universal approach to diagnosis and management is still lacking. The rapid decrease in blood glucose (BG) after birth triggers homeostatic mechanisms. Most episodes of hypoglycaemia are asymptomatic, and symptoms, when they occur, are nonspecific. Therefore, neonatologists are presented with the challenge of identifying infants at risk who might benefit from a rapid and effective therapy while sparing others unnecessary sampling and overtreatment. There is much controversy regarding the definition of hypoglycaemia, and one level does not fit all infants since postnatal age and clinical situations trigger different accepted thresholds for therapy. The concentration and duration of BG which cause neurological damage are unclear. Recognizing which newborn infants are at risk of hypoglycaemia and establishing protocols for treatment are essential to avoid possible deleterious effects on neurodevelopment. Early breastfeeding may reduce the risk of hypoglycaemia, but in some cases, the amount of breast milk available immediately after birth is insufficient or non-existent. In these situations, other therapeutic alternatives such as oral dextrose gel may lower the risk for NICU admissions. Current guidelines continue to be based on expert opinion and weak evidence. However, malpractice litigation related to neurodevelopmental disorders is frequent in children who suffered hypoglycaemia in the neonatal period even if they had other important factors contributing to the poor outcome. This review is aimed to help the practicing paediatricians and neonatologists to comprehend neonatal hypoglycaemia from physiology to therapy, hoping it will result in a rational decision-making process in an area not sufficiently supported by evidence.

Effect of Educational Intervention on Implementation of Neonatal Safety Standards

Background and Aim Patient safety in the neonatal intensive care unit (NICU) is one of the highest priority issues on the health care quality agenda worldwide. Efforts are needed to improve neonatal safety in NICU. The present study evaluated the effect of educational intervention on neonatal safety.

Materials and Methods Quasi-experimental study was conducted in three major hospitals, including the health care workers in their NICU during the period of study from May 2016 to May 2018. Neonatal safety standards were evaluated using an observational checklist after its validation by a pilot study. An intervention educational program was conducted in the three hospitals, followed by a reevaluation of the standards. All staff members (58 physicians and 69 nurses) participated in the three stages of the study.

Results The interventional program resulted in significant improvement of the health care workers implementation of the general (90.6 ± 15.1 vs. 127.6 ± 7.02, p = 0.016) and specific (50.6 ± 17.1 vs. 96.1 ± 13.2, p = 0.04) Egyptian Neonatal Safety Standards.

Conclusion Training and increasing the awareness of health care workers of the neonatal safety standards can significantly increase the fulfilment of these standards in both secondary and tertiary care neonatal units.

Hypoglycemia in High-Risk Infants Within the Immediate Postnatal Period

The incidence of hypoglycemia in the immediate postnatal period is rising because of the increasing rate of preterm births, maternal diabetes, and maternal obesity. Severe hypoglycemia has been considered a risk factor for neuronal cell death and adverse neurodevelopmental outcomes. The American Academy of Pediatrics (AAP) suggests a goal of ≥45 mg/dL (≥2.5 mmol/L) for infants who are asymptomatic within the first 48 hours. The Pediatric Endocrine Society (PES) suggests that infants who are unable to maintain their blood glucose >50 mg/dL (>2.77 mmol/L) within the first 48 hours or >60 mg/dL (>3.33 mmol/L) after the first 48 hours are at risk for persistent hypoglycemia. While there is disagreement for target glucose levels within the first 48 hours, both the AAP and the PES suggest further investigation for persistent hypoglycemia beyond 48-72 hours, which is beyond the scope of this article. However, in the immediate postnatal period, much can be gained with familiarization of the two guidelines, as well as current management techniques. This article presents current definitions and treatment modalities for management of hypoglycemia in infants considered at high risk in the immediate postnatal period.