Evidence Based Practice Advanced Cardiac Life Support Teaching Methods

1. By K. Tracy Bailey, R.N. Northeastern State University EBP Symposium April 23, 2010 Tracy_Bailey@chs.net Evidence Based PracticeAdvanced Cardiac Life Support Teaching Methods

2. Identification of a Clinical Problem �Between 370,000 and 750,000 hospitalized patients have a cardiac arrest and undergo cardiopulmonary resuscitation each year in the United States, with less than 30% expected to survive to discharge. Current recommendations are that hospitalized patient with Ventricular Fibrillation (V-Fib) or pulseless Ventricular Tachycardia (V-Tach) should receive defibrillation therapy within two minutes after recognition of cardiac arrest.� (Chan, Krumholz, Nichol, Nallamothu, 2008)

3. It�s a Matter of Safety! One facility instituted Code Blue drills to determine areas of weakness. To date, 20 drills have been completed Findings: Lack of knowledge of rhythms, medications, and current use of American Heart Association (AHA) guidelines Poor communication skills

4. Safety Continued� Outdated equipment ResusiAnnie has some defects Suction machine without battery operation Staff response time too long Inaudible overhead announcement Lack of physician participation In the absence of a physician, any ACLS certified person is team leader This increases staff anxiety Less than ideal attitudes of staff members Some staff feel the drills are taking away from �real� patients.

5. �Attention Please, Code Blue: Room 347��� Different departments have different duties. ED physician: Team Leader Critical Care: Crash Cart and Medications RT: Airway and Breathing Birth and Family: Chest Compressions Med Surg: Recording House Supervisor: Family and Crowd Control

6. Purpose Review the evidence to determine the most effective way to teach students and hardwire the ACLS curriculum in such a way to allow for retention of the information enabling them to proficiently manage the event until physician support arrives.

7. PICO question Among ACLS certified staff, do �code blue drills�, as compared to the current teaching style and computer based training, increase the retention of algorithms and current AHA guidelines, thereby improving patient outcomes, as noted by the Code Blue Committee.

8. Significance of the Problem �The delivery of cardiopulmonary resuscitation (CPR), with correctly performed chest compressions and ventilations, exerts a significant survival benefit in both animal and human studies. Interruptions in CPR or failure to provide compressions during cardiac arrest have been noted to have a negative impact on survival in animal studies.� (Abella, et al. 2005)

9. To Shock or not to Shock, That is the Question. . . One study showed Internal Medicine residents in a teaching facility, who were ACLS certified, felt they had lack of training and supervision necessary to successfully manage a patient in cardiac arrest. They felt unprepared and worried about significant error (Hayes, Rhee, Detsky, Leblanc, & Wax, 2007)

10. ACLS Training Computer based Time consuming (8 hours) Lack of social interaction Open 24/7 Classroom based Incorporates the use of video, hands on skills, and social interaction Must come prepared and utilize resources given (student CD, ECG & Pharmacology workbook) Time consuming (8-10 hours)

11. Simulation There are 3 different types of simulators Low Fidelity Use: to practice psychomotor skills such as a foam intramuscular injection simulator Moderate Fidelity More realism, offers heart sounds, pulse, breath sounds � lacks rise and fall of the chest High Fidelity (very costly) Realistic with attention to detail, provides a response to an intervention, giving it a �personality�

12. SimulationModerate Fidelity

13. SimulationHigh Fidelity

14. Will Simulation Help Retention of ACLS guidelines? A study by Roche and Giuliano (2010), has shown that medical simulation training improved the confidence and skills of medical residents� management of resuscitation, improved performance and ACLS skills, and improved assessment skills.

15. Retention of Guidelines Continued Wayne, et al. (2008), evaluated second and third-year physician residents in a hospital setting. The second-year residents received an ACLS course with simulation training featuring scenarios of cardiopulmonary arrest. The third-year residents received traditional ACLS training. During a 5 month time frame, both groups responded to ACLS events in their facility. Findings showed a significant improvement on the quality care provided by the second-year residents as well as adherence to AHA recommended guidelines, the quality of resuscitation efforts, and improvement in their procedural skills.

16. Approaches to the Problem The ACLS instructors needed to be more strict with pass/fail rate of the course All students will be given a copy of the ACLS manual All students will be given a student CD All students will be given the ECG & Pharmacology workbook The students will be expected to complete the student CD and bring their test results to class Obtain more up to date equipment, possibly a moderate fidelity simulator

17. Approaches to the Problem Simulation can enhance teamwork in a calm stress free environment under a safe, controlled setting without the thought of committing a grievous error to the patient Wooosaaa�

18. Leadership Support The ACLS instructors are held to a higher standard All the information obtained as a result of the code blue drills are funneled to the Administration Team We have been given $8000 for a new simulator based on this EBP project!!

19. One More Time We will continue with our Code Blue drills and resolve problems as they are observed. We are improving the way ACLS is taught with more expectations placed on the student. Obtain simulation equipment to help teach and improve on staff skill set and critical thinking.

20. QUESTIONS??