642 - Mobile Health-Guided Clinical Debriefing of Neonatal Resuscitations in the Democratic Republic of the Congo: The Role and Performance of Novice Nurse Midwife Facilitators

Publication Number: 3622.642

Kourtney R. Bettinger, University of Kansas School of Medicine, Prairie Village, KS, United States; Daniel Ishoso, Kinshasa School of Public Helth, Kinshasa, Kinshasa, Congo, (Congo – Kinshasa); Lauren D'Costa, RTI International, Durham, NC, United States; Sarah E. Sinsel, RTI International, York, PA, United States; Tracy Nolen, RTI International, RTP, NC, United States; Ingunn A. Haug, Laerdal Medical, Sandnes, Rogaland, Norway; Patricia Gomez, Jhpiego, Lacey, WA, United States; Benjamin Chi, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States; Jackie Patterson, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States

Background: Clinical debriefing can be an effective learning strategy to improve resuscitation care; however, its implementation can be challenging in low-resource settings due to a lack of trained facilitators. We developed a mobile health app called LIVEBORN that generates a customized script to support debriefing using real-time data from a resuscitation and evidence-based algorithms. To support clinical debriefing in the Democratic Republic of the Congo (DRC), we developed an implementation strategy that included training, mobile health-guided scripts, and ongoing coaching for on-site nurse facilitators.

Objective: To evaluate the performance of novice debriefing facilitators in a low-resource setting

Design/Methods: We implemented clinical debriefing for newborn resuscitation in two health facilities in Kinshasa as part of an interventional trial. Experienced midwives were selected as facilitators and received a full-day training in clinical debriefing, which included debriefing instruction, an emphasis on psychological safety, and simulated debriefing practice. During debriefings, facilitators used a customized debriefing script generated by the LIVEBORN app. Using a 3-section, 20-item debriefing checklist-informed by content expertise and literature reviews-coaches evaluated and scored debriefing meetings and then provided coaching based on their observations. Debriefing proficiency was defined as facilitators scoring ≥80% over five sessions, with demonstrated mastery of five mandatory items in the checklist (Table 1 [left column]).

Results: In Hospital A, three facilitators led debriefing activities for 77 cases (70 acute); in Hospital B, six facilitators supported 30 cases (13 acute; Table 2). Hospital A facilitators all completed secondary nursing school and had more than 10 years of clinical experience whereas Hospital B facilitators were licensed midwives and had more than 6 years of experience. All Hospital A facilitators achieved the coaching goal; only one facilitator at Hospital B achieved the goal with the remaining facilitators completing only 1 to 5 debriefings each (Table 3). Overall, facilitators scored highest on the effective introduction category followed by the creating a supportive environment category; they were least likely to follow the recommended debriefing process (Tables 1 and 3).

Conclusion(s): Novice facilitators became proficient at facilitation after a minimum of seven coaching sessions. Future analyses will focus on the effectiveness of this implementation strategy for clinical debriefing on resuscitation care and newborn outcomes.

Table 1. Checklist Content and Frequency of Satisfactory Scores for Individual Items on Debriefing Checklist
*Mandatory item for debriefing proficiency

Table 2. Overview of Debriefing Cases
1 Acute case defined as not crying by 60 seconds and/or requiring bag-mask ventilation and/or resulting in neonatal death.
2 Cases debriefed include 7 cases where the facilitator's debriefing was evaluated with a checklist but no notes on the content of the debriefing session nor who was present are available.
3 Cases debriefed also include 3 cases where the facilitator was not evaluated with a checklist; these 3 cases are not included in subsequent tables.


Table 3. Checklist Scores by Facilitator