Table 3.
Safety and ergonomic issues identified.
| Topic | Identified Challenges |
|---|---|
| Sterility | ● Current available respiratory equipment (CPAP mask, ventilation tubing) is not sterile, forcing clinicians to use a nonsterile piece of equipment adjacent to a sterile field with the theoretical risk of increasing surgical site infections. ● An ideal surface would provide adequate warmth to the vulnerable preterm infant. Current commercially available thermal mattresses are not sterile and require a workaround. ● Maintaining sterility requires more personnel than community hospitals may be able to staff. |
| Equipment | ● CPAP is ideally performed on a flat surface. However, there are limited options on how to best provide CPAP during DCC. Currently there is not an ideal surface and respiratory setup that allows for all infants to receive CPAP during DCC. ● Providers are often limited by the umbilical cord length to reach any available surfaces. |
| Mobility | ● Following DCC, the infant needs to be moved from the DCC site to a resuscitation bed or the intensive care unit. Concerns raised about the safety of moving a patient vulnerable to intraventricular hemorrhages multiple times in a short period (DCC to resuscitation bed to the ICU bed). An ideal setup would include minimal transportation and lifting of the infant. |
| Space and Workflow | ● In this new arrangement, the workflow was awkward. As there are multiple team members present at the mother’s side in a small space to provide DCC with CPAP, neonatal providers will often start from far away. There needs to be adequate time, space, and communication for the neonatal providers to safely approach the bed. |
| Communication | ● Obstetric providers voiced concerns about safety for the mother during DCC and emphasized the need for clear communication between the multidisciplinary teams. ● Neonatal providers request communication about when they are able to approach the mother safely in order to care for the infant. ● There is a need for protocols on when to discontinue DCC due to the infant or maternal status. |
CPAP, continuous positive airway pressure; ICU, intensive care unit.