Improving Respiratory Care for Neonatal Patients

Michelle Dungo-SalesIn 2006 an informal review of emergencies in St. Paul’s Hospital’s Neonatal ICU (NICU) found inconsistency in care and team expectations around respiratory therapy services. That’s when Michelle Dungo-Sales started improving and promoting safe delivery of neonatal respiratory care.

Respiratory therapists in the NICU are responsible for stabilizing and maintaining the airway as well as managing short-term mechanical ventilation while awaiting transfer of an infant to BC Children’s Hospital. Neonatal care is a specialized area of practice and the patient volume at St. Paul’s Hospital does not provide an opportunity for each RT to gain enough clinical experience to develop and maintain a comfortable level of expertise.

Even though Michelle’s primary role is as a clinical core therapist to the medical and surgical wards and also as a bronchoscopy therapist for pulmonary diagnostics, she took the lead on an initiative to build respiratory therapists’ confidence and competence – voluntarily and on top of her regular duties.

Michelle became the content developer, facilitator and presenter for the neonatal component of an annual Respiratory Therapy Department Skills Day. She began providing in-services for neonatal respiratory care to the therapists on an ad-hoc basis. She created a procedure manual and helped develop an area protocol as well as a Neonatal Quality Improvement/Quality Assurance Form that provides immediate feedback to leadership on areas for improvement; it also measures respiratory therapists’ confidence in performing neonatal procedures and service in the NICU. Michelle has now assumed responsibility for the form, which has provided data that shows a consistent improvement in therapists’ confidence overall and in specified NICU experiences.

Michelle expressed interest in becoming a Neonatal Resuscitation Program (NRP) Instructor and, in her spare time, soon became the first respiratory therapist teaching in Providence Health Care’s Maternity Program. Being an instructor has helped her develop better working relationships between respiratory therapists, paediatricians, anaesthetists, and RNs from the NICU and maternity unit. She has helped the number of respiratory therapists who are NRP certified grow from five to over 80 percent.

Michelle’s passion and dedication to patient care inspires her department to remain innovative and proactive in identifying opportunities to improve the quality of care. She is an excellent clinician, a dedicated patient advocate, a resource to her peers, and a supportive teacher. She is also recognized by her multi-disciplinary team for her collaborative approach to patient care and for her commitment to team work.