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Pediatric Nurses’ Level of Preparedness in Code Blue Response Flora Yuen, RN, BSN

Pediatric Nurses’ Level of Preparedness in Code Blue Response Flora Yuen, RN, BSN. To access PowerPoint presentation Go to http://www.fyuen79.wix.com/rn-msn or scan QR code Click on more  Thesis poster/ ppt

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Pediatric Nurses’ Level of Preparedness in Code Blue Response Flora Yuen, RN, BSN

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  1. Pediatric Nurses’ Level of Preparedness in Code Blue ResponseFlora Yuen, RN, BSN

  2. To access PowerPoint presentation • Go to http://www.fyuen79.wix.com/rn-msn or scan QR code • Click on more  Thesis poster/ppt • Scroll to the bottom of the page and click on the orange “P” to download this presentation.

  3. Objectives • Identify factors affecting the nurse’s performance during a resuscitation event. • Discuss strategies to improve the nurse’s performance during resuscitation events.

  4. Problem

  5. Stress and Fear • Participation in cardiopulmonary resuscitation of a patient is a stressful event for nurses • Described as the “most dreaded” event for those involved (Manderino, Yonkman, Gangong, & Royal, 1986) • “Scary,” “intimidating,” and “overwhelming” (Misko & Molle, 2003) • 23% of ICU nurses and 58% of non-ICU nurses cited emergency patient cardiac arrests as a stressful event in their jobs (Pups, Weyker, & Rogers, 1997) • Cause impaired memory, reduced concentration, delays in decision making (Norris & Lockey, 2012)

  6. Stress and Fear

  7. Frequency and Experience • Cardiopulmonary arrest in children occurs in 0.1%-0.3% of those admitted to the hospital (Hunt, Patel, Vera, Shaffner, & Pronovost, 2009) • Pediatric cardiopulmonary arrests are rare events as children often arrest secondary to hypoxia from respiratory failure or shock, unlike adults who arrest primarily due to cardiac etiologies • Cardiac arrests are rare events in departments other than ICUs and emergency departments. Approximately 62% of cardiopulmonary arrests in hospitals occur in intensive care units and the emergency department, while 37% occur on general wards (Peberdy et al., 2003)

  8. Frequency and Experience • Effect of rapid response teams on code blues • Implementation of a RRT in the pediatric population was associated with a reduction in both non-ICU cardiopulmonary arrest and hospital mortality (Chan et al., 2010; Sharek et al., 2007; Winters et al., 2013) • Lucile Packard Children’s Hospital study (Sharek et al., 2007) found a 71.2% decrease in code rates outside of the ICUs following implementation of RRTs

  9. CPR Skill and Retention • Simulated training vs. real event (Page & Meerabeau, 1996). • Retention of CPR skills and CPR knowledge decline quickly (Hamilton, 2005) • Basic life support and advanced life support skills and knowledge deteriorate significantly if it is not frequently practiced or updated (Dwyer & Williams, 2002) • Nurses and nursing students CPR skills were poor in terms of adequate and prompt assessment of the need for resuscitation and had only 50% success rate in effective artificial ventilation and chest compressions (Nyman & Sihvonen, 2000)

  10. CPR Skills and Retention • Without intervention to improve retention, CPR skills starts to decline within two weeks of training and continues to decline when tested at various intervals following training (Moser & Coleman, 1992 • CPR skills retention is found to be universally poor across all populations, including nurses, physicians, emergency medical technicians, and lay people (Moser & Coleman, 1992) • Retention of CPR knowledge is better than retention of CPR skills (O’Steen, Kee, & Minick, 1996)

  11. Research Questions • How do pediatric nurses rate his/her level of preparedness in initiating and participating in a code blue event that requires cardiopulmonary resuscitation? • What is the relationship between the pediatric nurse’s level of preparedness in code blue events that require cardiopulmonary resuscitation and the following: the number of years of nursing experience; the number of code blue events that the nurse has ever participated in; the length of time since the last code blue event that the nurse participated in; the types of training the nurse received on code blue response?

  12. Methodology • Quantitative, descriptive, correlational study • Setting: 365-bed pediatric hospital in a metropolitan city, Magnet hospital, level I trauma center with over 100 critical care beds, with inpatient and outpatient services, acute rehab, and emergency services • Participants: all pediatric registered nurses in the facility (1600 eligible RNs) • Survey instrument: 14-question researcher-designed survey administered online. Questions asked nurses to rate how prepared they are to perform each of 6 code roles, types of training, and experience in codes

  13. Findings • 306 total responses • 84 critical care nurses • 154 inpatient non-critical care nurses • 33 outpatient non-critical care nurses • Years of nursing experience range from less than one year to 53 years • Code blue experience • 36 have never participated in a code blue • 52 have not been in a code for more than 3 years • 40 have not participated in a code blue for at least 1 year

  14. Results

  15. Results

  16. Results

  17. Results • Of the 6 code roles, nurses reported being least prepared to perform the role of medication nurse • Correlation between nurse preparedness and all 4 factors, strongest correlation being the length of time since the last event (r=-0.31, p<0.01) • Of the types of training received, there was no correlation between nurse’s preparedness and BLS, ACLS, or PALS training. Significant correlation between nurse’s preparedness and participation in mock codes (r=0.27, p<0.001)

  18. Strategies • Code role assignments each shift • Daily check in by charge nurse with each nurse with assigned role • Ongoing review and practice sessions of one selected role each month • Regularly schedule mock codes for both shifts • Debriefing session with team members following code blue events • Monthly mock code task force meeting to review progress and debrief of all code/RRT events in past month • Invite all staff involved in those events to attend debriefing

  19. References • Chan, P. S., Jain, R., Nallmothu, B. K., Berg, R. A., & Sasson, C. (2010). Rapid response teams: A systematic review and meta-analysis. Archives of Internal Medicine, 170(1), 18-26. Retrieved from http://dx.doi.org/doi:10.1001/archinternmed.2009.424 • Dwyer, T., & Williams, L. M. (2002). Nurses’ behaviour regarding CPR and the theories of reasoned action and planned behaviour. Resuscitation, 52(1), 85-90. • Hamilton, R. (2005). Nurses’ knowledge and skill retention following cardiopulmonary resuscitation training: A review of the literature. Journal of Advanced Nursing, 51(3), 288-297. Retrieved from http://dx.doi.org/10.1111/j.1365-2648.2005.03491.x • Hunt, E. A., Patel, S., Vera, K., Shaffner, D. H., & Pronovost, P. J. (2009). Survey of pediatric resident experiences with resuscitation training and attendance at actual cardiopulmonary arrests. Pediatric Critical Care Medicine, 10(1), 96-105. • Manderino, M. A., Yonkman, C. A., Gangong, L. H., & Royal, A. (1986). Evaluation of a cardiac arrest simulation. Journal of Nursing Education, 25, 107-111. • Misko, L., & Molle, E. (2003). Beyond the classroom: Teaching staff to manage cardiac arrest situations. Journal for Nurses in Staff Development, 19(6), 292-296. • Moser, D. K., & Coleman, S. (1992). Recommendations for improving cardiopulmonary resuscitation skills retention. Heart & Lung, 21, 372-380. • Norris, E. M., & Lockey, A. S. (2012). Human factors in resuscitation teaching. Resuscitation, 83(4), 423-427. • Nyman, J., & Sihvonen, M. (2000). Cardiopulmonary resuscitation skills in nurses and nursing students. Resuscitation, 47(2), 179-184.

  20. References • Page, S., & Meerabeau, L. (1996). Nurses’ accounts of cardiopulmonary resuscitation. Journal of Advanced Nursing, 24(2), 317-325. Retrieved from http://dx.doi.org/10.1111/1365-2648.ep8555528 • Peberdy, M., Kaye, W., Ornato, J. P., Larkin, G. L., Nadkarni, V., Mancini, M. E., ... Lane-Truitt, T. (2003). Cardiopulmonary resuscitation of adults in the hospital: A report of 14,720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation, 58(3), 297-308. http://dx.doi.org/doi:10.1016/S0300-9572(03)00215-6 • Pups, G. M., Weyker, J. D., & Rodgers, B. L. (1997). Nurses’ reactions to participation in cardiopulmonary resuscitation on the nursing unit. Clinical Nursing Research, 6(1), 59-70. • O’Steen, D. S., Kee, C. C., & Minick, M. P. (1996). The retention of advanced cardiac life support knowledge among registered nurses. Journal of Nursing Staff Development, 12(2), 66-72. • Sharek, P. J., Parast, L. M., Leong, K., Coombs, J., Earnest, K., Sullivan, J., ... Roth, S. J. (2007). Effect of a rapid response team on hospital-wide mortality and code rates outside the ICU in a children’s hospital. JAMA, 298(19), 2267-2274. Retrieved from http://dx.doi.org/doi:10.1001/jama.298.19.2267 • Winters, B. D., Weaver, S. J., Pfoh, E. R., Yang, T., Pham, J. C., & Dy, S. M. (2013). Rapid-response systems as a patient safety strategy: A systemic review. Annals of Internal Medicine, 158(5), 417-426. Retrieved from http://dx.doi.org/doi:10.7326/0003-4819-158-5-201303051-00009

  21. Questions?

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