The objective is to provide a structured postgraduate neonatal competency-based training for 15 junior doctors working within the VNCH neonatal intensive care unit and 12 junior doctors working within the Hanoi OBGY. This training will support their development to delivering good standards of safe care and developing clinical leadership and management skills to produce professionals sensitive to the needs of children and their families.
The training is adapted from the UK Royal College of Paediatrics and Child Health Level 1 and Level 2 curriculum and delivered over a three-year period. The programme is taught by UK consultant neonatologists from leading NHS Hospital Trusts.
The aim is to raise all junior doctors’ level of knowledge about neonatal care and improve their ability to provide high-quality care by facilitating objective assessment of their progress, recognising those reaching a competency level that will allow them to work safely at middle grade, and supporting and teaching new junior members of the medical team at the hospital and in the provincial and district hospitals.
The objective of the training is to provide an education structure that will improve and refine neonatal nursing care among qualified nurses, with the goal of improving neonatal outcomes and assist in the reduction of morbidity and mortality in Hanoi. Through this dedicated neonatal nurse education programme, 53 nurses working in the VNCH will be provided with detailed embryology, physiology and pathophysiology related to the neonate and the disease process they encounter. Nurses will learn how to aptly respond to these illnesses and conditions by providing skilled, evidenced-based nursing care and management that also integrates the family as a whole. This education programme provides a culture that nurtures learning and education, making it central to care provision. The training is equivalent to UK Higher and Further Education, Framework Level 4 and is taught by Edinburgh Napier University. The programme will support the development of a national neonatal nurse training curriculum.
This educational package aims to support local teams in the provincial hospitals to improve resuscitation skills and recognition of the sick newborn, to provide guidance on immediate care and stabilisation and to suggest frameworks for escalation of care when relevant. The expectation is that this implementation will improve mortality and reduce long-term disability by facilitating optimal care close to home whilst also expediting timely referral to the tertiary centre with improved clinical conditions during transfer. Consistency of care across differing neonatal unit providers would be supported using shared patient care pathways, algorithms and clinical guidelines. This education package has been designed as a stepping stone to the implementation of a fully managed network with outreach education and a centrally co-ordinated transport service.
In Vietnam, even after admission to a high-level hospital, newborns often die or are damaged for life, thereby placing a heavy burden on their parents and families. While the quality of the hospitals and the availability of equipment and supplies is an issue, poor care, failure to recognise a sick newborn, no standard referral criteria and long travel distances without safe transport are major factors in poor outcomes.
Many deaths could be averted with appropriate resuscitation and good basic care in the first hours of life — the restructuring of services delivered by appropriately trained staff with strict protocols for the stabilisation and timely transfer of babies who need a higher level of care and a safe transfer system, to ensure that neonates would be quickly and safely moved to a unit with a higher level of care as necessary.
The MoH has approved our proposal for a pilot managed network system within Hanoi with different levels of care at hospitals according to their capacity, subject to the outcome the network system will be rolled out across Hanoi and the 28 northern provinces.
To support the network system, a transport service will be developed, adequately equipped and resourced, to transfer babies to and from provincial hospitals and the specialist centre; these transfers include ‘uplifts’ in care of sick babies to the VNCH as well as ‘repatriations’ back to the provincial hospitals. Most uplifts are considered urgent transfers, some of which will be ‘time-critical’ transfers where a baby needs to be brought to VNCH as a matter of the utmost urgency.
Medical and nursing teams undertaking transfers will have specialist transport training experience. A fit for purpose neonatal transport service will be developed to provide all aspects of neonatal care support on the move, including full monitoring equipment, various respiratory support modalities, intravenous infusion pumps and a facility to provide therapeutic hypothermia. This will be achieved using a ‘transport incubator’ which can be moved on a bespoke trolley and can be secured safely in the transport vehicle.
In Vietnam, there is no mandatory resuscitation training for healthcare professionals involved in the delivery and care of newborn infants. The first hour of life for a premature infant represents a period during which the infant faces challenges that carry risks of short and long-term injury, lifelong developmental delay and death. Delivery room personnel have the opportunity to impact the transitional process, positively or negatively. During this period, the clinician is faced with complex decisions based on multiple systems that require attention and knowing that care in these first minutes of life can translate into lifelong medical problems.
While resuscitation courses are numerous, the training is not mandatory and there is no single standard. Addressing this deficit would significantly improve survival and outcomes. Newborns Vietnam and the Vietnam National Children’s Hospital have joined forces to set up a Vietnam National Resuscitation Council (VNRC) under the European Resuscitation Council regulations. The VNRC would be Vietnam’s national body for Newborn Life Support and Advanced Paediatric Life Support. The aim is for Newborn Life Support and Advanced Paediatric Life Support training to be mandatory for doctors, nurses, midwives and first responders.
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