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Nawathe P, Garland J, Cuzzolina J, Salinas N, Dodd B, Grein J. Simulation as Proof of Concept to Assess the Feasibility and Address Uncertainties Regarding Cardiopulmonary Resuscitation in an Adolescent Patient With Viral Hemorrhagic Fever. Simul Healthc 2024:01266021-990000000-00140. [PMID: 39133109 DOI: 10.1097/sih.0000000000000820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
INTRODUCTION While general management guidelines exist for patients with viral hemorrhagic fevers (VHF), uncertainty surrounds the extent to which critical care interventions should be provided. There has been significant concern in providing cardiopulmonary resuscitation (CPR) to a patient with VHF due to concerns regarding CPR efficiency and the safety of the healthcare team. However, data on CPR feasibility, efficiency, and latent safety threats (LSTs) to the healthcare team in patients with VHF needing CPR are lacking. Our team proactively studied this in the simulation environment as the first step to guiding evidence-based and ethically informed decisions about CPR for these patients. METHODS We studied CPR metrics, times to critical interventions, and LSTs using systems-focused debriefing in an adolescent patient with VHF who had pulseless electrical activity. This exercise included 3 members inside the patient room in full PPE and special pathogens team members in modified PPE outside the room. RESULTS We found that CPR is feasible in full PPE. The chest compression fraction was 72%, with an average manual rate of 129 compressions per minute and an average manual depth of 2.1 inches. We identified multiple LSTs in the debriefing and video analysis. CONCLUSIONS This simulation study showed that CPR in a patient with VHF is possible in full PPE with a minimum of 3 team members. However, we identified physical and psychological LSTs with the systems-focused debriefing. Therefore, refining roles and responsibilities would be necessary to improve the safety of the healthcare team and improve the quality of CPR.
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Affiliation(s)
- Pooja Nawathe
- From the Guerin Children's, Department of Pediatrics (P.W.); Special Pathogens Program (J.G., J.C.); Department of Emergency Medicine (N.S.); Women's Guild Simulation Center for Advanced Clinical Skills and Innovation (B.D.); and Hospital Epidemiology (J.G.), Cedars-Sinai Medical Center, Los Angeles, CA
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Kahsay DT, Salanterä S, Tommila M, Liukas T, Rosio R, Diji AKA, Peltonen LM. User Needs and Factors Associated With the Acceptability of Audiovisual Feedback Devices for Chest Compression Monitoring in Cardiopulmonary Resuscitation. Comput Inform Nurs 2024; 42:583-592. [PMID: 38470258 DOI: 10.1097/cin.0000000000001126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
The use of audiovisual feedback devices to guide the quality of chest compressions during cardiopulmonary resuscitation has increased in recent years. Audiovisual feedback devices can be classified as integrated (eg, Zoll AED Plus defibrillator) or standalone (eg, CPRmeter). This study aimed to explore users' needs and factors affecting the acceptability of audiovisual feedback devices. Semistructured interviews were conducted with healthcare professionals involved in lifesaving activities. The Unified Theory of Acceptance and Use of Technology was used as a theoretical framework for the study. The Unified Theory of Acceptance and Use of Technology model has four constructs: performance expectancy, effort expectancy, social influence, and facilitating factors. Ten themes were identified under the four constructs. The performance expectancy constructs include three themes: perceived usefulness, outcome expectation, and applicability in diverse situations. The effort expectancy construct encompasses two themes: user-friendliness and complexity. The social influence construct has two themes: social and organizational factors. Lastly, the facilitating factors construct includes three themes: staff competence, perceived cost, and compatibility of devices. Exploring the needs and factors influencing the acceptability of audiovisual feedback devices used during cardiopulmonary resuscitation will inform healthcare providers, managers, manufacturers, and procurers on how to improve the efficiency and use of these devices.
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Affiliation(s)
- Desale Tewelde Kahsay
- Author Affiliations: Department of Anaesthesiology and Intensive Care, Faculty of Medicine, University of Turku (Mr Kahsay); Department of Nursing Science, Faculty of Medicine, University of Turku and Turku University Hospital, Turku, Finland (Drs Salanterä and Peltonen), and Department of Perioperative Services, Intensive Care Medicine and Pain Management (Dr Tommila), Turku University Hospital and University of Turku; and Department of Nursing Science, Faculty of Medicine, University of Turku (Ms Liukas), Finland; Department of Nursing, Kwame Nkrumah, University of Science and Technology, Ghana (Dr Diji)
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Song E, Issenberg SB, Roh YS. Effects of Prebriefing Using Online Team-Based Learning in Advanced Life Support Education for Nurses. Comput Inform Nurs 2023; 41:909-914. [PMID: 37580050 DOI: 10.1097/cin.0000000000001056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
An effective prebriefing strategy is needed that can improve the learning outcomes of nurses in advanced life support education. This study aimed to identify the effects of prebriefing with online team-based learning on hospital nurses' knowledge, performance, and self-efficacy in advanced life support education. A nonequivalent control group pretest-posttest design was adopted. Nurses in the experimental group (n = 26) participated in prebriefing using online team-based learning followed by self-directed learning, whereas nurses in the control group (n = 27) experienced only self-directed learning before advanced life support education. Wilcoxon signed-ranks tests were used to identify the posttest-pretest differences of the study variables in each group. Both groups showed improved knowledge, individual performance, and self-efficacy after the education. Nurses in the experimental group reported higher self-efficacy scores compared with those in the control group. There were no differences between the experimental and control groups in knowledge, individual performances, or team performance. Online team-based learning as a prebriefing modality resulted in greater improvements in self-efficacy in advanced life support education.
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Affiliation(s)
- Eunkyoung Song
- Author Affiliations: Seoul Metropolitan Government Seoul National University Boramae Medical Center, Republic of Korea (Ms Song); University of Miami Miller School of Medicine, FL (Dr Issenberg); Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea (Dr Roh)
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Mota S. Resuscitation Quality Improvement: Improving Clinicians' Performance. AACN Adv Crit Care 2023; 34:182-188. [PMID: 37644632 DOI: 10.4037/aacnacc2023833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND Although cardiopulmonary resuscitation (CPR) renewal occurs every 2 years, quality of performed CPR at the study site was below American Heart Association (AHA) standards. Resuscitation Quality Improvement (RQI) is a new AHA program with the premise that practicing CPR more frequently using audiovisual feedback can improve performance. OBJECTIVE To identify whether performance of chest compressions during training reassessments improves with RQI. METHODS This study used a preintervention-postintervention design. Critical care nurses from 2 intensive care units performed a baseline round of chest compressions. These baseline data reflected CPR performance with traditional training. The next week, participants completed RQI training. Two weeks after RQI training, participants performed chest compressions. Five weeks after RQI training, participants performed a third round of chest compressions. The compressions performed 2 and 5 weeks after RQI used audiovisual feedback. RESULTS Thirty nurses participated. Before intervention, the mean (SD) for overall compression compliance was 32.68% (26.96%), depth was 67.76% (30.15%), and rate was 39.95% (27.41%). The first postintervention (RQI plus 2 weeks) mean (SD) increased to 75.33% (33.70%) for overall compression compliance, 97.43% (12.04%) for depth, and 80.89% (29.35%) for rate. The second postintervention (RQI plus 5 weeks) mean (SD) decreased slightly to 73.16% (36.36%) for overall compression compliance, 96.57% (13.04%) for depth, and 78.75% (31.83%) for rate. CONCLUSION Frequent CPR using RQI technology, with its immediate audiovisual feedback, helps maintain skills, which may improve patient outcomes.
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Affiliation(s)
- Sergio Mota
- Sergio Mota is Director, Clinical Research Nursing, Emory University, 21364 Clifton Rd. NE, Atlanta, GA 30322
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de Castro LT, Coriolano AM, Burckart K, Soares MB, Accorsi TAD, Rosa VEE, de Santis Andrade Lopes AS, Couto TB. Rapid-cycle deliberate practice versus after-event debriefing clinical simulation in cardiopulmonary resuscitation: a cluster randomized trial. ADVANCES IN SIMULATION (LONDON, ENGLAND) 2022; 7:43. [PMID: 36578096 PMCID: PMC9798613 DOI: 10.1186/s41077-022-00239-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/10/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Rapid-cycle deliberate practice (RCDP) is a simulation-based educational strategy that consists of repeating a simulation scenario a number of times to acquire a planned competency. When the objective of a cycle is achieved, a new cycle initiates with increased skill complexity. There have been no previous randomized studies comparing after-event debriefing clinical manikin-based simulation to RCDP in adult cardiopulmonary resuscitation (CPR). METHODS We invited physicians from the post-graduate program on Emergency Medicine of the Hospital Israelita Albert Einstein. Groups were randomized 1:1 to RCDP or after-event debriefing simulation prior to the first station of CPR training. During the first 5 min of the pre-intervention scenario, both groups participated in a simulated case of an out-of-hospital cardiac arrest without facilitator interference; after the first 5 min, each scenario was then facilitated according to group allocation (RCDP or after-event debriefing). In a second scenario of CPR later in the day with the same participants, there was no facilitator intervention, and the planned outcomes were evaluated. The primary outcome was the chest compression fraction during CPR in the post-intervention scenario. Secondary outcomes comprised time for recognition of the cardiac arrest, time for first verbalization of the cardiac arrest initial rhythm, time for first defibrillation, and mean pre-defibrillation pause. RESULTS We analyzed data of three courses conducted between June 2018 and July 2019, with 76 participants divided into 9 teams. Each team had a median of 8 participants. In the post-intervention scenario, the RCDP teams had a significantly higher chest compression fraction than the after-event debriefing group (80.0% vs 63.6%; p = 0.036). The RCDP group also demonstrated a significantly lower time between recognition of the rhythm and defibrillation (6 vs 25 s; p value = 0.036). CONCLUSION RCDP simulation strategy is associated with significantly higher manikin chest compression fraction during CPR when compared to an after-event debriefing simulation.
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Affiliation(s)
- Leandro Teixeira de Castro
- grid.413562.70000 0001 0385 1941Centro de Simulação Realística, Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627, São Paulo, SP 05652-900 Brazil
| | - Andreia Melo Coriolano
- grid.413562.70000 0001 0385 1941Centro de Simulação Realística, Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627, São Paulo, SP 05652-900 Brazil
| | - Karina Burckart
- grid.413562.70000 0001 0385 1941Centro de Simulação Realística, Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627, São Paulo, SP 05652-900 Brazil
| | - Mislane Bezerra Soares
- grid.413562.70000 0001 0385 1941Centro de Simulação Realística, Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627, São Paulo, SP 05652-900 Brazil
| | - Tarso Augusto Duenhas Accorsi
- grid.413562.70000 0001 0385 1941Centro de Simulação Realística, Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627, São Paulo, SP 05652-900 Brazil
| | - Vitor Emer Egypto Rosa
- grid.413562.70000 0001 0385 1941Instituto Israelita de Ensino E Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Thomaz Bittencourt Couto
- grid.413562.70000 0001 0385 1941Centro de Simulação Realística, Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627, São Paulo, SP 05652-900 Brazil
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Gugelmin-Almeida D, Tobase L, Maconochie I, Polastri T, Rodrigues Gesteira EC, Williams J. What can be learned from the literature about intervals and strategies for paediatric CPR retraining of healthcare professionals? A scoping review of literature. Resusc Plus 2022; 12:100319. [PMCID: PMC9630773 DOI: 10.1016/j.resplu.2022.100319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/28/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022] Open
Abstract
Background Effective training and retraining may be key to good quality paediatric cardiopulmonary resuscitation (pCPR). PCPR skills decay within months after training, making the current retraining intervals ineffective. Establishing an effective retraining strategy is fundamental to improve quality of performance and potentially enhance patient outcomes. Objective To investigate the intervals and strategies of formal paediatric resuscitation retraining provided to healthcare professionals, and the associated outcomes including patient outcomes, quality of performance, retention of knowledge and skills and rescuer’s confidence. Methods This review was drafted and reported using the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews (PRISMA-ScR). PubMed, Medline, Cochrane, Embase, CINAHL Complete, ERIC and Web of Science were searched and studies addressing the PICOST question were selected. Results The results indicate complex data due to significant heterogeneity among study findings in relation to study design, retraining strategies, outcome measures and length of intervention. Out of 4706 studies identified, 21 were included with most of them opting for monthly or more frequent retraining sessions. The length of intervention ranged from 2-minutes up to 3.5 hours, with most studies selecting shorter durations (<1h). All studies pointed to the importance of regular retraining sessions for acquisition and retention of pCPR skills. Conclusions Brief and frequent pCPR retraining may result in more successful skill retention and consequent higher-quality performance. There is no strong evidence regarding the ideal retraining schedule however, with as little as two minutes of refresher training every month, there is the potential to increase pCPR performance and retain the skills for longer.
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Key Words
- paediatric cardiopulmonary resuscitation
- training strategies
- retraining intervals
- scoping review
- healthcare professionals
- apls, advanced paediatric life support
- atls, advanced trauma life support
- bls, basic life support
- cpr, cardiopulmonary resuscitation
- em, emergency medical
- ems, emergency medical services
- epals, european paediatric advanced life support
- ilcor, international liaison committee on resuscitation
- pcpr, paediatric cardiopulmonary resuscitation
- pals, paediatric advanced life support
- phpls, pre-hospital paediatric life support
- pils, paediatric intermediate life support
- rct, randomised controlled trial
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Affiliation(s)
- Debora Gugelmin-Almeida
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth Gateway Building, St. Pauls Lane, Bournemouth BH8 8GP, England,Corresponding author.
| | - Lucia Tobase
- Centro Universitário São Camilo, Rua Raul Pompeia, 144, São Paulo, Brazil
| | - Ian Maconochie
- Paediatric Emergency Medicine, St Mary's Hospital, Imperial College NHS Healthcare Trust, London, UK
| | - Thatiane Polastri
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, Brazil
| | | | - Jonathan Williams
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth Gateway Building, St. Pauls Lane, Bournemouth BH8 8GP, England
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Cogan ES, Thomas LMB. Improving CPR quality through high-performance resuscitation team training. Nursing 2022; 52:57-59. [PMID: 36006755 DOI: 10.1097/01.nurse.0000854016.95250.ac] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Elizabeth S Cogan
- Elizabeth Cogan completed her DNP at the University of Nevada in Reno, Nev., where Lisa Thomas is an associate professor
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Ji J, Wang L, Guan H, Jiang Y, Zhou S, Sheng J, Wang L. The Effect of Group Random Quality Control on the First Aid Ability of Ward Doctors and Nurses with Respect to the Resuscitation of Patients with In-Hospital Cardiac Arrest. Risk Manag Healthc Policy 2021; 14:4553-4560. [PMID: 34785964 PMCID: PMC8590839 DOI: 10.2147/rmhp.s334142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/30/2021] [Indexed: 12/02/2022] Open
Abstract
Objective This study was designed to verify the effect of group random quality control on the first aid ability of ward doctors and nurses with regard to the resuscitation of patients with in-hospital cardiac arrest (IHCA). Methods The first aid quality control team of our hospital was established in December 2018, when the number, qualifications, organizational structure, quality control methods, and responsibilities of the team and team members were determined. The baseline data and assessment results of examinees, the rates of return of spontaneous circulation (ROSC), and the discharge survival rate of IHCA patients in 2019 and 2020 were compared. Results There were no significant differences in the baseline data of examinees at each stage (p > 0.05). As time went on, the results of the four practical examinations were significantly improved (pairwise comparison, p < 0.05). The number of problems in examinations was significantly higher for physicians than for nurses. After guidance in department relearning, the incidence of related problems was significantly reduced, but the mastery of the frequency and depth of extracorporeal cardiac compression were not always up to standard. The proportion of critically ill patients and the incidence of IHCA in the hospital in 2020 was higher than in 2019 (p < 0.05), and the ROSC rate was also significantly higher than it was in 2019 (p < 0.05), but the difference in the survival rate at discharge was not statistically significant (p > 0.05). Conclusion Group random quality control meets the needs of IHCA emergencies, and it can improve the first aid skills and organizational coordination of doctors and nurses on the ward through continuous discovery and problem solving so that the ultimate goal of improving the success rate of resuscitation can be achieved.
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Affiliation(s)
- Jianhong Ji
- Intensive Care Unit, The Second Affiliated Hospital of Nantong University, Nantong, People's Republic of China
| | - Li Wang
- Department of Emergency, The Second Affiliated Hospital of Nantong University, Nantong, People's Republic of China
| | - Haiyang Guan
- Department of Emergency, The Second Affiliated Hospital of Nantong University, Nantong, People's Republic of China
| | - Yaqiong Jiang
- Intensive Care Unit, The Second Affiliated Hospital of Nantong University, Nantong, People's Republic of China
| | - Sanlian Zhou
- Department of Emergency, The Second Affiliated Hospital of Nantong University, Nantong, People's Republic of China
| | - Junhua Sheng
- Department of Medical, The Second Affiliated Hospital of Nantong University, Nantong, People's Republic of China
| | - Lihua Wang
- Department of Nursing, The Second Affiliated Hospital of Nantong University, Nantong, People's Republic of China
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