By Dr Pong Kwai Meng, Dr Cheang Hon Kit and Dr Hwang Yee Chern

It all started after Kwai Meng returned from Sydney, Australia in 2009 when he had completed his 2 years of neonatal training at the Royal Hospital for Women. During his stint with NSW Newborn and Paediatric Emergency Transport Service (NETS), a neonatologist from Canada introduced the S.T.A.B.L.E. program to him. Subsequently he wrote to the author/founder of the program, Kristine Karlsen, who was so helpful in providing him with various teaching materials of the program, i.e. the S.T.A.B.L.E. learner and instructor manuals, CD Roms and teaching slides to initiate the program in his hospital.

After the first informal training session of the program for 22 nurses in Penang Adventist Hospital in March 2011, there was very good feedback from the nurses about the program. Therefore, Kwai Meng decided to share this program with his colleagues in Penang.

Hon Kit and Yee Chern (Three of us are neonatologists from the Penang Paediatric Network   who share the same passion in teaching) shared the same idea that we should introduce this  program into Malaysia as the content of this well constructed program is extremely useful to all healthcare workers dealing with sick and premature infants  In order for us to implement this program efficiently, we decided that we should be trained and certified as lead instructors to meet the qualification and requirement set by the S.T.A.B.L.E. Program.

The idea was well received by Allied Health Care Centre of Excellence (AHCoE) which is an organisation aiming to promote allied health professional training in the northern region. With its sponsorship, we started our journey to Chicago to attend the National Instructor Course and Intro to Simulation and the S.T.A.B.L.E. Scenarios Workshop on 27-29 April  2011.

The National Instructor course held at Chicago which we attended set a new record for state and international representation. There were total number of 62 delegates, consisting of NICU nurses, doctors and a respiratory therapist from 26 states in USA and 3 countries (Saudi Arabia, Mexico and Malaysia). Everybody was impressed with our enthusiasm to travel all the way from Malaysia to attend the instructor course at Chicago.

Kris Karlsen, the founder and author of STABLE Program conducted the 2-day National Instructor course single-handedly! It was really amazing to find out that all these years, she actually conducted all the S.T.A.B.L.E. National Instructor courses, which are held three times per year in U.S.A.

The most stressful part of the course was to pass the pretest with a minimum score of 70% in order to be certified as a lead instructor. Luckily the questions were not too tough and we all made it!

It was quite an eye-opening experience for us to attend the national instructor course along with other local participants, who are mostly senior neonatal nurses such as neonatal nurse practitioners, NICU clinical nurse specialists and NICU nurse educators. We were deeply impressed with the professionalism and skillfulness of this group of S.T.A.B.L.E. instructor-to- be neonatal nurses in handling neonatal emergencies and situations when we observed how they performed during the simulation sessions. It was a testimony to show the effectiveness of the S.T.A.B.L.E. program as part of their training to be a neonatal intensive care nurse. In fact, we learned that the S.T.A.B.L.E. program completion certificate is a pre-employment requirement to work in nurseries, NICU and labour rooms in the United States..

What is S.T.A.B.L.E. Program ?

Hundreds of times each day, in hospitals and communities around the world, newly born infants become ill and require specialized care. Each member of the health care team—nurses, physicians, therapists and assistants—must know what to do for the sick infant. Their care must be provided in a timely, efficient, anticipatory, and effective manner. This early transitional care affects not only the immediate health of the infant, but also the infant’s long-term outcome.

Many nurses, physicians, and other members of the health care team have limited experience in stabilizing sick newborns. It is often a challenge for hospital staff to maintain knowledge and skill in this area. The Neonatal Resuscitation Program (NRP) focuses on delivery room resuscitation. Following resuscitation, caregivers must turn to other resources for the necessary ongoing and supportive care.

The S.T.A.B.L.E. Program was developed to meet the educational needs of health care providers who must deliver this important stabilization care. S.T.A.B.L.E. education is critical to the mission to reduce infant mortality and morbidity and to improve the future health of children and their families.

S.T.A.B.L.E. is the most widely distributed and implemented neonatal education program to focus exclusively on the post-resuscitation/pre-transport stabilization care of sick infants. Based on a mnemonic to optimize learning, retention and recall of information, S.T.A.B.L.E. stands for the six assessments and care modules in the program: Sugar, Temperature, Airway, Blood pressure, Lab work, and Emotional support. A seventh module, Quality Improvement stresses the professional responsibility of improving and evaluating care provided to sick infants.

First introduced in US and Canada in 1996, S.T.A.B.L.E. has grown internationally to include instructor training and courses in more than 45 countries including Qatar, Romania, Spain, Thailand, Uganda, United Arab Emirates, United Kingdom and Vietnam etc. Of course, the program is available in Malaysia now!  The program has been translated into Spanish, Lithuanian, Latvian, and Romanian. Currently, there are more than 3,600 registered instructors worldwide and more than 225,000 neonatal healthcare providers have completed the S.T.A.B.L.E. Learner course.

In 2003-2004, the March of Dimes conducted an extensive review of the program. Reviewers included nationally known physicians and nurses in the field of neonatal care. The experts agreed that the S.T.A.B.L.E. Program is accurate and of high quality, meets an important need, and is relevant to the March of Dimes mission and our prematurity campaign. The March of Dimes has endorsed the S.T.A.B.L.E program for use by health caregivers.

In 2006, Executive Committee of the American Academy of Pediatrics (AAP) Section on Transport Medicine formally reviewed the S.T.A.B.L.E program and concluded : “ The  S.T.A.B.L.E. course is the pre-eminent educational program for pre-NICU and transport team professionals alike on the essentials  in the management of unstable neonates awaiting transport and NICU admission.”

The Founder of S.T.A.B.L.E. Program

Dr. Kristine Karlsen is the National Program Director, Founder and Award-Winning Author of the internationally recognized S.T.A.B.L.E. Program. She is a neonatal nurse practitioner with 26 years of working experience in Level 3 NICUs and transportation of sick neonates in the Intermountain Healthcare System in Utah. She is actively involved in neonatal education for healthcare professionals. Dr. Karlsen is a skilled, entertaining, and knowledgeable lecturer, who participates frequently in conference presentations both nationally and internationally. Her research interests include methods to improve neonatal outcomes, the educational process and teacher attributes.

How is the program administered?

The S.T.A.B.L.E. Program Learner Course involves an eight-hour, interactive presentation by an expert in neonatal nursing or medicine. Continuing education credits are provided by individual instructors. Instructor courses are offered throughout the year in USA to prepare lead instructors for course presentation. There is shorter version of the program (5 hours) which is also called a physician edition and renewal course.

Who should take the S.T.A.B.L.E. Program Learner Course?
Stabilisation is a team effort!  Any health caregiver who is involved with post-resuscitation or pre-transport care of sick newborns or who provides well-baby care:
Physicians: Pediatric, ER and family practice physicians, including residents
Nurses: RNs working in labour rooms, postpartum, nursery, ER; nurse midwives; nursing assistants
Others: Respiratory therapists; pre-hospital providers ( Emergency Medical Technicians and paramedics)
Participants must achieve a minimum passing score of 85% in the post-test to be awarded the Learner Course completion cards. Similar to NRP, the cards are valid for two years. Therefore, renewal is recommended every two years.

An introduction to simulation: S.T.A.B.L.E. Program

During the Chicago trip, we also managed to attend a full-day workshop of Introduction to Simulation of S.T.A.B.L.E. Program on 29 April 2011. The Simulation workshop is designed to introduce students to the principles of simulation-based-training. This interactive seminar includes an overview of how to accomplish simulation using a holistic construct of cognitive, behavioral and technical skills. Methods in briefing students for the simulation experience, facilitator and technician considerations, how to run a scenario, debriefing do’s and don’ts, and what to expect from high fidelity simulation mannequins were taught and discussed. We also learned more about the features of the high-fidelity neonatal mannequin-  Gaumard’s Neonatal Hal. (Available in Malaysia too.)

The S.T.A.B.L.E. Program : Cardiac Module

The S.T.A.B.L.E. – Cardiac Module is one of the modules available for the S.T.A.B.L.E Program. It is used as a stand-alone presentation/course for physicians, nurses, respiratory therapists, and other health care providers. It provides general guidelines for the assessment and stabilization of neonates with suspected congenital heart disease (CHD).

The S.T.A.B.L.E. Program: Physical Exam and Gestational Age Assessment Module

This module supplements the S.T.A.B.L.E Program Learner Course or can be used as a stand-alone presentation for interns, residents, nurses, respiratory therapists, and other health care providers. Highly visual with more than one hundred ninety beautifully created and animated slides to help students learn everything from Ballard gestational age assessment to a head-to-toe physical examination and immediate stabilization of neonates with various surgical conditions including omphalocele, gastroschisis, tracheoesophageal fistula, midgut volvulus, subgaleal hemorrhage, and more.

To learn more information about the S.T.A.B.L.E. Program, please log on to http://www.stableprogram.org or contact us at the following e-mail address:

Dr. Pong Kwai Meng  : pongkwaimeng@pah.com.my
Dr. Cheang Hon Kit    : cheanghk@hlwe.com
Dr. Hwang Yee Chern : hwangyeechern@gmail.com

Please download the Full Article below for further reading..

Click Here to Download