New opportunity to improve pediatric emergency preparedness: pediatric emergency assessment, recognition, and stabilization course

Preparedness for Life-Threatening Situations in a Pediatric Tertiary-Care University Children’s Hospital: A Survey

Pediatric nurses and physicians are rarely exposed to life-threatening events. Understanding the needs of clinicians is key for designing continuing training programs. A survey exploring preparedness to manage life-threatening events as well as training needs was mailed to all clinically active nurses and physicians at a tertiary-level referral children’s hospital. Overall, 469 participants out of 871 answered the questionnaire (54% response rate). Respondents felt well or very well (nurses 93%, physicians 74%) prepared to recognize a deteriorating child and rated their theoretical understanding (70% well or very well prepared) of how to manage life-threatening situations significantly higher (p < 0.0001) than their cardiopulmonary resuscitation (CPR) preparedness (52% well or very well prepared). Both perceived theoretical understanding (p < 0.0001) and CPR preparedness (p < 0.002) were rated higher among nurses than physicians. Arrhythmias, shock, cardiac arrest and airway management constitute main areas of perceived training need. In conclusion, although a majority of pediatric nurses and physicians felt sufficiently trained to recognize a deteriorating child, their perceived ability to actively manage life-threatening events was inferior to their theoretical understanding of how to resuscitate a child. A high degree of institutional confidence and identification of areas of training need provide a good foundation for customizing future continuing education programs.

Pediatric in-hospital emergencies: real life experiences, previous training and the need for training among physicians and nurses

Objective

Pediatric emergencies challenge professional teams by demanding substantial cognitive effort, skills and effective teamwork. Educational designs for team trainings must be aligned to the needs of participants in order to increase effectiveness. To assess these needs, a survey among physicians and nurses of a tertiary pediatric center in Germany was conducted, focusing on previous experience, previous training in emergency care, and individual training needs.

Results

Fifty-three physicians and 75 nurses participated. Most frequently experienced emergencies were respiratory failure, resuscitation, seizure, shock/sepsis and arrhythmia. Resuscitations were perceived as being particularly precarious. Team collaboration and communication were major issues arising from previous emergency situations, but perceptions differed between physicians and nurses. Regarding previous training, physicians were accustomed to self-directed learning, whereas nurses usually attended practical courses. Both physicians and nurses rated themselves as having moderate levels of knowledge and skills for pediatric emergencies, though residents reported the significantly lowest preparedness. Both professions reported a high need for training of basic procedures and emergency algorithms, physicians even more than nurses.

Cardiopulmonary arrest in the outpatient setting: enhancing patient safety through rapid response algorithms and simulation teaching

Ambulatory and outpatient centers constantly are challenged with administrating cancer treatments in an efficient and safe way. With the advent of numerous novel cancer medications known to cause hypersensitivity reactions, nurses have become experts in managing these emergencies. However, patients rarely exhibit severe infusion reactions or cardiopulmonary arrest. Outpatient nurse knowledge and comfort with grade 4, life-threatening emergencies requiring cardiopulmonary resuscitative measures often is low because of infrequent occurrence. That is largely a result of nurses' ability to immediately identify the need for emergency intervention, thus preventing the sequelae of patient deterioration that could lead to cardiopulmonary arrest. This article describes how the authors' institution developed methods to improve emergency care by bridging the gap between knowledge and experience of handling life-threatening emergencies.

The implementation of PEARS training: supporting nurses in non-critical care settings to improve patient outcomes

Children's Hospital Boston's Life Support Program began offering the newly developed American Heart Association Pediatric Emergency Assessment, Recognition and Stabilization (PEARS) course for nurses working in non-critical care settings in December of 2007. The goal was to provide an appropriate alternative to pediatric advanced life support (PALS) training for clinical staff caring for the general pediatric population. To date, more than 900 nurses have completed the course with feedback from the participants being extremely positive. Even more impressive is a more appropriate use of the hospital's emergency medical response system promoting early intervention and the significant reduction in cardiac arrests on inpatient units. During a 12-month period, nurses involved in activations of the response system were asked to rate their ability to assess, categorize, decide and act after each event. The overwhelming majority agreed they were able to apply the PEARS systematic approach of assessment and early intervention to the situation. This article describes the planning and implementation of PEARS training for non-critical care nursing staff and provides data that demonstrates improved patient outcomes. Supporting activities and strategies promoting early recognition and interventions contributing to the successful reduction of cardiac arrests on inpatient units are also discussed.

An education program on office medical emergency preparedness for primary care pediatricians

BACKGROUND

Pediatric clinics are ill-prepared in handling medical emergencies. Life-support education, though recommended, has not been evaluated in pediatric primary care.

PURPOSE

The objective is to evaluate effectiveness of education in improving knowledge and learner-perceived comfort in managing pediatric office emergencies.

METHODS

An education program was conducted at 6 pediatric practices. Pre-post program knowledge improvement (15-item questionnaire) and comfort (10-level Likert scale) was assessed using T tests and Cohen's d. Long-term knowledge was assessed.

RESULTS

Physicians demonstrated significant improvement in mean knowledge scores: 1.83, 95% confidence interval (CI) [0.76, 2.91], effect size (d=0.98), whereas nurses had a smaller, nonsignificant improvement: 0.59, 95% CI [-0.19, 1.37], effect size (d=0.24). A significant improvement in mean comfort scores was observed among both physicians: 1.3, 95% CI [0.9, 1.7] and nurses, 1.4, 95% CI [0.7, 2.1]. Among physicians, percentage correct answers on the knowledge test was 79% (baseline), 91% (posttest), and 80% at 3 years.

CONCLUSIONS

Education in pediatric office emergency preparedness leads to short-term knowledge improvement among physicians, but gains are not sustained.