Neonatal Intensive Care Unit

In late August 2011, a magnitude 5.8 earthquake the strongest east of the Mississippi since 1944 shook Washington, D.C., with such force that it cracked the Washington Monument and damaged the National Cathedral. On the sixth floor of the neonatal intensive care unit (NICU) at Children’s National in Washington, D.C., staff felt the hospital swaying from side to side.

After the shaking stopped, they found the natural disaster expose another fault: The unit’s 200-plus staff members were not all equally knowledgeable or confident regarding the unit’s plan for evacuating its 66 newborns or their own specific role during an emergency evacuation. More than 900 very sick children are transfer to Children’s National NICU from across the region each year, and a high percentage rely on machines to do the work that their tiny lungs and hearts are not yet strong enough to do on their own.

Neonatal Intensive Care Unit

Transporting fragile babies down six flights of stairs along with vital equipment that keeps them alive requires planning, teamwork and training. Children’s National is the nation’s No. 1 NICU; its educators work with a diverse group within Children’s National to design and implement periodic evacuation simulations. From June 2015 to August 2017, 213 members of neonatal intensive care unit staff took part in simulate drills; honing their skills by practicing with mannequins with varying levels of acuity.

The two-hour evacuation simulation training at Children’s National begins with a group prebrief. During this meeting, NICU educators discuss the overarching evacuation plan, outline individual roles and give a hands-on demonstration of all of the evacuation equipment. This equipment includes emergency backpacks, a drip calculation sheet and an emergency phrase card. Emergency supply backpacks are fill with everything that each patient needs post evacuation, from suction catheters, butterfly needles and suture removal kits to flashlights with batteries.

Each room is equipped with that emergency backpack which is secure in a lock cabinet. Every nurse has a key to access the cabinet at any time. Vertical evacuation scenarios are design to give trainees a real world experience. Mannequins that are intubate are evacuate by tray, allowing the nurse to provide continuous oxygen with the use of a resuscitation bag during the evacuation. Evacuation by sled allows three patients to be transport simultaneously. Patients with uncomplicated conditions can be lift out of their cribs and swiftly carried to safety.

Designated charge nurse

An “X” on the door designates rooms already evacuated. A designate charge nurse and another member of the medical team remain; so in the unit until the final patient is evacuate to make a final sweep. The simulate training ends with a debrief session during which issues that arose during the evacuation are identify and correct prior to subsequent simulate trainings; improving the safety and expediency of the exercise.

Indeed, as Children’s National NICU staff master these evacuation simulations; evacuation times drop from 21 minutes to as little as 16 minutes. Equally important, post evacuation surveys indicate; 86% of staff report being more comfortable in being able to safely evacuate the Children’s National NICU. 94% of NICU staff understand the overall evacuation plan; also 97% of NICU staff know their individual role during an evacuation.

“One of the most surprising revelations regard one of the most basic functions; so in any neonatal intensive care unit,” Dr. Soghier adds. “Once intravenous tubing is remove from its pump; the rate at which infusions drip needs to be calculate manually. They create laminate cards with pre calculate drip rates to enable life saving fluid delivery to continue without interruption.”