It's a wrap! Protecting gastroschisis bowel

Oral Presentation 3
Mr Ahmed Mohamed, Dr Sarah Berry, Mrs Collette Donnelly, Mrs Evelyn Ervine

It's a wrap! Protecting gastroschisis bowel

INTRODUCTION
Gastroschisis is a congenital defect of the anterior abdominal wall defect characterised by the herniation of abdominal contents through a defect usually located on the right side of the umbilical cord. (1) Team-working, collaboration and clear communication between the obstetric, neonatal, and paediatric surgical teams are critical to achieving optimal outcomes in GS. (2) A national cohort study of all surgical units in the UK and Ireland identified primary closure as the most common intended surgical management for antenatally detected cases of simple gastroschisis. (3) A local retrospective audit in our department identified a higher rate of staged gastroschisis repair in the last 10 years with 66% of patients requiring initial silo placement, when compared to 36% national average. (3) Local data also demonstrated that patients with silo placement took longer to achieve full feeds, prolonged TPN, delayed discharge, and increased complication rates.

OBJECTIVES
To create an interprofessional simulation programme for the preparation and management of a gastroschisis delivery, resuscitation, and initial stabilisation. Aims of this project are to improve awareness of optimal stabilisation management, the efficiency of bowel wrapping and clear communication amongst the multidisciplinary team with the overall goal of improving the rate of primary closure and outcomes in our unit.

METHODS
A gastroschisis simulation model was created using vegan sausage casings, jelly, and food colouring to create the bowel. The simulation programme focused on; team education of optimal GS management, team and delivery room preparation, primary resuscitation and bowel wrapping with cling film. Following a lecture on gastroschisis management and a demonstration of delivery room stabilisation, participants were divided into teams of five, given a scenario, asked to prepare equipment, allocate roles and work in sync to achieve effective resuscitation and stabilisation of the newborn. Pre and Post simulation feedback was collected and the course was adapted using a PDSA cycle.

OUTCOMES
Pre-simulation: 56% of participants had no previous training or clinical experience of the management of gastroschisis and 78% did not feel confident in providing delivery suite management and stabilisation. 100% of attendees felt the simulation training improved their confidence of initial management and stabilisation of gastroschisis and all would recommend this course to their peers.

CONCLUSION
Simulation-based interdisciplinary team training can serve as a channel for the acquisition and maintenance of clinical skills and is crucial to improving the management of complex neonatal conditions.