Employing a Novel Tool for Supportive Clinical Supervision Following Helping Babies Breathe Training in Selected Ethiopian Delivery Room Settings for Targeted Quality Improvement Initiatives

Purpose/Objectives: Helping Babies Breathe (HBB) is a simulation-based curriculum developed to standardize neonatal resuscitation and basic newborn care in low-to-middle income countries. Improvements in neonatal morbidity and mortality following HBB training are inconsistent without ongoing skills practice and integration into local health facilities. We aimed to develop a model of supportive clinical supervision following HBB training to assess clinical skills, identify equipment deficiencies and systems-based barriers to curriculum implementation using a novel checklist tool (Figure 1).

Design/Methods: US-based HBB Master Trainers were unable to conduct in-country study activities due to the global COVID-19 pandemic. Alternatively, four graduates of Ethiopia’s first Masters of Neonatal Nursing Program (NNP) were recruited to lead curriculum implementation and conduct clinical observations. Baseline knowledge of 12 Masters of NNP students was assessed, followed by a 4-day HBB simulation training course and Objective Structured Clinical Evaluation (OSCE). Master Trainers subsequently observed students implementing HBB in tertiary delivery rooms and completed the HBB Clinical Skills Checklist to characterize barriers to curriculum completion.

Results: Students entered the program with wide range of previous years nursing experience (range: 3-11 years) in varied health care settings. 9/12 (75%) students had completed HBB training prior to the study period (range: 2-7 years). Mean score ± SD for pre- and post-curriculum evaluation is reported: HBB Knowledge Check 95 ± 4%, Bag-Mask Ventilation Skill Check 90% ± 8% and OSCE B 96 ± 4%. Master Trainers assessed students during a convenience sample of 6 daytime deliveries (Table 1). Equipment deficiencies were identified, including a lack of gloves, suction, cloths and preterm masks. As a result, 4/6 infants were not “dried thoroughly”. Students appropriately identified “not breathing” and initiated bag-mask ventilation within The Golden Minute®. Contrary to HBB protocol, cords were cut immediately for all infants. 4/5 infants triaged to Routine Care were not placed skin-to-skin per OB request. Clinical supervisors noted open doors and windows, significant distance between the delivery and resuscitation area and no water source for hand washing or equipment decontamination.

Conclusion/Discussion: Despite the range of clinical experience and prior HBB training, students performed consistently well on OSCE B. Delivery room observations revealed equipment deficiencies that hindered thorough drying. Systems-based barriers prevented delayed cord clamping, immediate skin-to-skin, timely placement in the resuscitation area, environmental thermoregulation and infection control. This model of supportive clinical supervision aids in translating HBB skills from the classroom to local health care systems by identifying barriers to curriculum implementation for targeted quality improvement initiatives. The clinical checklist tool enables tracking of program quality indicators in the domains of clinical performance and facility preparedness. Testing this model on a larger scale with alternative formats for data collection tools (i.e. smartphone Apps) is needed to enable adaptation to other countries where HBB is employed.