Preparedness of Western Cape ALS providers to provide clinical stabilisation and intensive care for neonates during the patient journey

Abstract

Abstract

The management and intensive care of neonates is inherently prone to adverse events, particularly as such management often involves pre-term neonates in distress – this means they have been born too early and their frail bodies require external support in order to survive. In the Western Cape high-risk neonates who are being referred from one neonatal intensive care unit (NICU) to another such unit or from primary and secondary hospitals to NICU are transported by ALS providers. However, there is a paucity of evidence relating to the preparedness of these ALS providers for the management and continuum care of these critically ill neonates. This study showed the general lack of neonatal exposure as the clinical management of critically ill neonates ranged from once in six months (n = 17, 11.7%) to a group of 6.9% (n = 6) who indicated that they had never managed critically ill neonates. The lack of frequency of employing the critical ALS skills of neonatal intubation (n = 62, 42.8%) and neonatal CPR (n = 49, 33.8%) cited, reflected the lack of opportunity to use such skills frequently in the pre- hospital environment. Only 9.7% (n = 14) of the respondents indicated they had the necessary specialised monitoring equipment to safely transfer neonates and only 14.5% (n = 21) of the respondents felt “well-prepared” to manage critically ill neonates. There is an urgent need to standardise both the theory and the practicum components for all ALS provider neonatal training programmes. The ideal would be the establishment of a mentorship programme, supervised by neonatologists. Additional neonatal short course/refresher training is also needed which includes the design of Continued Professional Development (CPD) accredited activities. In order to improve patient safety, the procurement of sufficient specialised neonatal intensive care equipment and disposables, especially for the rural ALS providers, should be prioritised. Elements before, during and after the inter-facility transfer of a critically ill neonate by ALS providers were explored. This study suggests that these factors may impact on the emotional and mental preparedness of the ALS providers, possibly hampering their ability to provide optimum care.