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Neonatal resuscitation is a common and important intervention. It is also a stressful and sometimes chaotic experience. Recollections of events may be inaccurate and teaching and learning in such circumstances are difficult. Video can accurately document events during delivery room (DR) resuscitation; it can therefore be used to assess compliance with guidelines and the effect of interventions.
In many hospitals photographs or video recordings of infants can only be made with written parental permission. It is difficult and may be inappropriate to prospectively obtain parental permission to video all DR resuscitations. When a high-risk delivery is imminent, parents are invariably anxious and mothers may be in pain or unwell. They may thus be unable to give permission appropriately. If previous permission is needed, it is only possible to record resuscitations where there is considerable advance warning. This seriously limits the applicability of the findings because infants born after an unanticipated emergency, likely to be the most ill and thus of most interest, are excluded.
We wished to audit the care given to newborns in the DRs of our hospital. Here, we describe the ethical and legal issues we encountered before we commenced recording DR resuscitations at our hospital.
AUDIT AND QUALITY ASSURANCE
Audit is the testing of current practice against previously established guidelines or benchmarks; this contrasts with research, which is aimed at the discovery of new knowledge that is intended ultimately to help establish guidelines. In general, previous informed consent of participants is a prerequisite for research, but not for audit. Quality assurance activities are an integral part of healthcare delivery.1 Healthcare providers recognise the need to ensure that their service is of a high quality and consistent with available resources; and that not to do so is unethical.2 First reported in the 1960s,3 videotaping emergency medical procedures has long …
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