MANAGEMENT OF SICK AND SMALL NEWBORNS FACILITATOR GUIDE TO CLINICAL PRACTICE 2ND EDITION, JULY 2015 This work is licensed under a CC BY 4.0 International License. Facilitator guide to Practical’s 2nd edition 1 FACILITATORS GUIDE TO CLINICAL PRACTICE .................................................................................. 3 PRACTICAL 1: WORKING IN THE NEONATAL UNIT, INFECTION PREVENTION AND A NEUROPROTECTIVE ENVIRONMENT. ............................................................................................ 6 PRACTICAL 2 & 3: ASSESS AND CLASSIFY DEMONSTRATION AND PRACTISE ............................. 9 PRACTICAL 4: Demonstrate and Practise Assess Risk Factors and special treatment needs ...... 11 PRACTICAL 5: Maintain normal body temperature ............................................................................. 13 Practical 6: Oxygen therapy ................................................................................................................... 15 Practical 7: Demonstration and practice of feeds and fluids calculations ........................................ 18 PRACTICAL 8: Ballard Score ................................................................................................................ 19 PRACTICAL 9: KMC PART 1: The KMC unit ......................................................................................... 20 KMC 9: PART 2: Assisting mothers in placing babies in KMC .......................................................... 22 PRACTICAL 10 KMC DAILY SCORE SHEET ......................................................................................... 23 PRACTICAL 11: ASSESS WEIGHT GAIN IN LBW BABY ..................................................................... 26 PRACTICAL 12 JAUNDICE ..................................................................................................................... 28 PRACTICAL 13 NEONATAL ENCEPHALOPATHY (HIE) ...................................................................... 29 PRACTICAL 15: CPAP ............................................................................................................................ 30 PRACTICAL 18: CREATING A NEURODEVELOPMENTAL SENSITIVE NNU ENVIRONMENT FOR THE PRETERM INFANT .................................................................................................................. 34 PRACTICAL 19: INFANT MOTOR ASSESSMENT ................................................................................. 36 PRACTICAL 20: UMBILICAL VEIN LINE INSERTION ........................................................................... 37 PRACTICAL 21: X-RAY INTERPRETATION .......................................................................................... 39 Still to be developed ............................................................................................................................... 39 PRACTICAL 22: CLEANING AND STERILISING EQUIPMENT AND NEONATAL WARD ................... 40 PRACTICAL 23: ASSESSING AND ASSISTING WITH BREASTFEEDING .......................................... 41 PRACTICAL 24: EXPRESSING BREAST MILK AND CUP FEEDING ................................................... 43 2 Facilitator guide to Practical’s 2nd edition FACILITATORS GUIDE TO CLINICAL PRACTICE Clinical practice is an essential part of this course that provides daily practice in using case management skills so participants can perform proficiently. Participants learn skills by reading modules. They practice in class by doing exercises or case studies and importantly, in clinical practice. They practice using their skills with newborns in the neonatal unit. The table below provides an overview and of the practical sessions in the training courses. Practical Training Module Module subsection Duration of practical Practical 1 Principles of Infection prevention in the neonatal unit, including 40 minutes treatment hand washing, and neuroprotection Practical 2 Assess and classify Demonstrate A&C 40 minutes Practical 3 Assess and classify A&C, Need for emergency signs and priority signs, 40 minutes injuries, abnormalities and local infection Practical 4 Assess and classify A&C risk factors and special treatment needs 40 minutes Practical 5 Principles of Maintain normal body temp: using a manual and 40 minutes treatment servo control incubator Practical 6 Principles of Oxygen therapy 40 minutes treatment Practical 7 Principles of Feeds and fluids 40 minutes treatment Practical 8 Specific treatment: Ballard score 40 minutes LBW Practical 9 Specific treatment: KMC, Skin-to-skin, managing and monitoring in 40 minutes LBW KMC Practical 10 Specific treatment: KMC, discharge use the tool and assess 40 minutes LBW Practical 11 Specific treatment: Assess weight gain 40 minutes LBW Practical 12 Specific treatment: Jaundice, check bilirubin, manage phototherapy 40 minutes Jaundice Practical 13 Neonatal Monitor and Manage infant with NE, 40 minutes encephalopathy Practical 14 HIV, TB, Syphilis HIV and syphilis 40 minutes Practical 15 CPAP CPAP – demonstrate use of CPAP VIDEO 40 minutes Practical 16 CPAP CPAP – assembling and setting up CPAP machine 40 minutes Practical 17 CPAP CPAP – initiating, monitoring and adjusting 40 minutes Practical 18 Development In development 40 minutes Assessment Practical 19 Infant Motor In development 40 minutes Assessment Practical 20 Umbilical Cord Drip In development 40 minutes Practical 21 XRay interpretation In development 40 minutes Practical 22 Principles of Cleaning and sterilising equipment and surfaces in 40 minutes treatment the NNU Practical 23 Routine care Assessing and assisting with breast feeding 40 minutes Practical 24 Routine care Expressing breast milk and cup feeding 40 minutes Facilitator guide to Practical’s 2nd edition 3 4 Facilitator guide to Practical’s 2nd edition ROLE OF FACILITATORS DURING CLINICAL SESSIONS: Before clinical session begins the facilitator will visit the neonatal unit. The purpose of this is to introduce herself to the unit manager and doctor in charge of the neonatal unit and explain the nature of the clinical practice to be conducted until the end of the course. In preparation for the 5 days clinical session the facilitator will: • Visit the neonatal unit to identify sick babies • Meet with neonatal staff and confirm all logistics • Identify babies relevant for the clinical practice • Assemble all relevant equipment for all clinical stations • Give clear instruction to participants before clinical session • Divide participants into groups of 4 - 6 SETTING AND PARTICIPANTS Clinical practicals are conducted in the neonatal unit with adequate number of sick neonates for participants to get an opportunity of identifying all relevant signs. There should be a participant ratio of 4 - 6 participants per facilitator. Ideally the total participants should range between 16 -18 per course with minimum of 3 facilitators. Participants will then be divided into small groups of 4-6. These groups will then rotate through all 3 stations in the clinical area and spend about 40 minutes at each station. CLINICAL PRACTICE OBJECTIVES During clinical practice sessions participants will: • Get an instruction on how clinical practice will be performed • See demonstrations on how to assess babies • See examples on how to practice the principles of newborn care as well as specific treatments • Practices assess and classify of sick babies • Practise the principles of care such as thermoneutral environment, oxygen and CPAP, KMC • Observe and discuss how to prevent infections • Learn how a neonatal unit functions Facilitator guide to Practical’s 2nd edition 5 PRACTICAL 1: WORKING IN THE NEONATAL UNIT AND INFECTION PREVENTION Duration 40 minutes PURPOSE: To orientate participants to the neonatal unit, infection prevention, and ensuring a neuro-protective environment. EQUIPMENT AND SUPPLIES NEEDED: Soap and paper towels SPACE NEEDED: • Handwash area for deMonstration and practice • Review of neonatal unit, isolation area, and process of cleaning and infection control in the unit • Space around an incubator for deMonstration and practice – probably interMediate care area MATERIAL NEEDED: • Newborn care charts pg 45 • Hand- washing chart CLINICAL CASES NEEDED: • One baby in an incubator PREPARATION: 1. ENSURE THAT THE HAND-WASHING AREA HAS THE FOLLOWING FOR YOUR DEMONSTRATION. o Basin with elbow tap o Soap/D-gem o Paper towel o Pedal bin o Wall poster guide 2. VISIT THE NEONATAL UNIT AND REVIEW THE PROCESS THAT THE NEONATAL UNIT USES FOR INFECTION CONTROL SO THAT YOU WILL BE ABLE TO DEMONSTRATE THE FOLLOWING • The isolation area • Hand washing areas • Cleaning of walls and floors • Cleaning of equipment • Cleaning of surfaces • Handling of nappies and linen • Handling of sharps 3. REVIEW THE NEURO-PROTECTIVE ENVIRONMENT FOR A BABY IN THE UNIT SO YOU CAN DEMONSTRATE ( SEE PRACTICAL 18) • A baby nested and protected in an incubator • Appropriate clothing for baby in an incuabator ( Hat, booties, nappy and clothes ) • Wall therMoMeter and temperature Management • Lighting in the unit, and how babies can sleep. • VoluMe of alarMs, and noise control DEMONSTRATION Facilitator guide to Practical’s 2nd edition 6 HAND WASHING • Store bags and excess clothes and jewellery away froM the clinical area • Go to hand-washing area • DeMonstrate hand-washing • Have everyone wash their hands correctly – see chart. INFECTION CONTROL Conduct a round of the ward and deMonstrate the following to particiapnts GUIDELINE ON PREVENTION AND CONTROL OF INFECTION ¨ There should be adequate space