767 - Neonatal Bubble CPAP Training, Implementation and Resulting Clinical Practice in Ghana- Part of the Making Every Baby Count Initiative (MEBCI 2.0)

Publication Number: 767.5639

Anna B. Hedstrom, University of Washington School of Medicine, Seattle, WA, United States; Kwabena Onwona-Agyeman, Greater Accra Regional hospital, Accra, Greater Accra, Ghana; Von Vivita C. Peters, KYBELE, Inc, Staten Island, NY, United States; Kumi Ampaabeng Kyeremeh, N/A, Accra, Greater Accra, Ghana; Gifty Osei. Akoto, N/A, Accra, Greater Accra, Ghana; Victoria Flanagan, Geisel School of Medicine at Dartmouth, White River Jct, VT, United States; Beena D. Kamath-Rayne, American Academy of Pediatrics, Itasca, IL, United States; carlos Ramos, University of California San Diego, San Diego, CA, United States; Riana Riffle, Endeavor Health, Teaching Affiliate of the University of Chicago Pritzker School of Medicine, Chicago, IL, United States; Margaret A.. Chinbuah, Kybele, Tema, Greater Accra, Ghana; Lawrence Fordjour, State University of New York Downstate Medical Center College of Medicine, Brooklyn, NY, United States; Medge Owen, Wake Forest School of Medicine, WINSTON SALEM, NC, United States

Background: Bubble CPAP is an effective intervention proposed for scale-up to reduce mortality in premature infants. Limited data exist on how to accomplish this in a low resource health system. The Making Every Baby Count Initiative 2.0 (MEBCI 2.0) aimed to scale-up high-quality advanced newborn care, including bCPAP, at 4 regional hospitals in Ghana from 2020-2024.

Objective: We describe the bCPAP training, implementation, clinical care and ongoing challenges.

Design/Methods: This mixed methods descriptive study collected retrospective clinical data, structured clinical care observations , and staff cognitive knowledge, before and after the bCPAP specific interventions below (figure 1):
- Serial clinical/equipment evaluations
- Staff training and clinical mentoring by internal champions and external RN/RT/MD teams
- Device installation/maintenance
- Champion-led QI projects
- Creation of a country-wide bCPAP guideline

Results: Prior to bCPAP implementation, 39% of the 82 patients on respiratory support were treated with improvised bCPAP, 78% without continuous pulse oximetry and 72% (10/18) had oxygen saturations outside the ideal range. (table 1)
The bCPAP training modules were taught to 208 learners over two days, and mean pre/post test scores improved from 46-59% to 80-83%. QI projects demonstrated two sites improving to >80% of patients maintained within targeted oxygen saturation range.
Bedside review of 6 weeks of bCPAP records one year after implementation revealed 33% (58/178) were treated primarily with 21% oxygen and the group had 74% (135/183) survival. When patients were evaluated by an external team, 71% (20/28) of patients had goal saturations and 39% (11/28) had nasal redness or breakdown.
Ongoing challenges included RAM cannulas hardening from re-use, difficulty performing frequent bedside reassessments and titrations due to low staffing ratios and lack of RT presence or established in-service training.

Conclusion(s): We report bCPAP implementation and scale aligned with the goals of the WHO’s Care for Small and Sick Newborn and the Ghana National Newborn Health Strategy and Action Plan (2019-2023). This bCPAP program included mentorship of local staff as champions and resulted in improved staff knowledge and clinical practice. Delivery of quality bCPAP requires experienced staff and current care challenges are linked to limited staff retention and staffing levels inadequate for delivery of intensive care. Sustainability of bCPAP care will require coordinated national strategy to support clinicians and improve outcomes.

Figure 1: Timeline of assessments, training and bCPAP implementation during the MEBCI 2.0 Project.
Figure 1.pdfQI = quality improvement, RT= respiratory therapist, RN = nurse, MD= doctor

Table 1. Clinical data before and after bCPAP implementation at four study sites.
Table 1. 17 Oct.pdfData includes bedside clinical observations of bCPAP patients by external evaluation team (A-prior to implementation and B- 1 year after), chart review of six weeks of patients treated with bCPAP (1 year after implementation) and D- one year of chart review bCPAP data from site 1

Figure 1: Timeline of assessments, training and bCPAP implementation during the MEBCI 2.0 Project.
Figure 1.pdfQI = quality improvement, RT= respiratory therapist, RN = nurse, MD= doctor

Table 1. Clinical data before and after bCPAP implementation at four study sites.
Table 1. 17 Oct.pdfData includes bedside clinical observations of bCPAP patients by external evaluation team (A-prior to implementation and B- 1 year after), chart review of six weeks of patients treated with bCPAP (1 year after implementation) and D- one year of chart review bCPAP data from site 1