Illinois Valley Community Hospital
After introducing the American Heart Association’s Resuscitation Quality Improvement (RQI) Program, a groundbreaking new approach to maintaining competency in CPR, Illinois Valley Community Hospital realized multiple benefits:
- High levels of staff acceptance due to improved understanding of resuscitation skills measurement and increased practice frequency
- Increased confidence among staff that they were prepared to handle emergent CPR and resuscitation situations
- Ability to provide training and skills assessment to staff on multiple shifts at more convenient times
- Enhanced IVCH reputation in community as a provider and employer committed to adopting advanced technology in the interest of providing the best possible care
In 2010, the American Heart Association (AHA) recommended a move to more frequent training and assessment of CPR skills. Historically, the skill has been taught and evaluated every two years. However, recent research has shown that the psychomotor skills used in CPR actually begin to decay within three to six months. Because poor CPR skills can lead to episodes of preventable harm to patients, the AHA has set a goal of increasing “Sudden Cardiac Arrest (SCA) survival-to-discharge rates from 19% to 38% by 2020.”
Given the rapid decay of CPR skills, hospitals are left with a rather significant challenge—how to preserve resuscitation skills and insure that patients are receiving optimal care. The research suggests a need for much more frequent CPR training. What is the best way to insure that patient care providers are getting the recommended training at the recommended interval? Illinois Valley Community Hospital (IVCH) has solved this problem with an innovative solution from AHA. In January, they were the first hospital in Illinois to implement the RQI Program.
Renee Rebholz, IVCH’s Director of Education, recently shared her experience and that of IVCH with the implementation and introduction of RQI. Like most of her colleagues at small, rural hospitals, Ms. Rebholz works hard to insure that IVCH’s 700 employees receive the training and certifications that they need and shared with us that in the past, “It was very hard to maintain competency and make sure that patient care staff had unexpired CPR cards. The size of the hospital staff made training difficult—it was a challenge to provide coverage on the nursing units and departments while trying to provide the training every two years and the necessity of providing it on a more frequent basis seemed a daunting task.”
Ms. Rebholz offered that it was a struggle to get enough classes done at the right time and that it was difficult to find the time to do the training in addition to her other jobs. She frequently had to make time to do additional training for the hospital-owned physician office practices and other off-site organizations that are owned by the hospital in addition to the one-on-one training that was often necessary. Ms. Rebholz also noticed something that new AHA Guidelines and research have quantified—“our staff felt as if they weren’t skilled enough because (with the exception of the ER and the ICU) they weren’t using the skills often enough during the two-year training intervals. There was a level of learning that we were losing and we could see it during the training.”
Ms. Rebholz assumed that she would always be dealing with these challenges until attending HealthStream’s annual Summit customer conference, where she learned about RQI and the Simulation Station—a mobile cart that contains everything needed for quarterly training— adult and infant Voice-Assisted Manikins (VAMs), bag-valve masks, and a tablet computer. “The fact that this took less time and could be brought right to the student rather than the other way around was very persuasive for me. Of course, the results showed that more regular practice leads to greater competence was extremely persuasive as well.”
Ms. Rebholz also spoke to the practical matter of how to fund the RQI implementation for IVCH. Like virtually all hospitals, IVCH did not have an unlimited education budget so Ms. Rebholz had to get creative. She approached the IVCH Foundation for help. “The Foundation got excited when I told them what this could do. They understood that they had contributed to making a difference in patient’s and employee’s lives.”
While it is still too early to quantify clinical results (the program began in January 2016), IVCH has surveyed the program’s participants in an attempt to measure program efficacy and acceptance of the new training modality. Acceptance for the program is extraordinarily high, but Ms. Rebholz shared that many nurses were actually shocked to learn that they had been doing compressions incorrectly. The VAM provides audio feedback on hand positioning, compression rate and depth and ventilation rate that an alternative CPR manikin simply cannot provide.
“This allows all patient care staff to have a comfort level that they are doing CPR correctly—they know because they’ve just done it. People believe that this is going to make them better at this skill. It provides them with the insight to do it better every time. They changed how they did compressions and said that ventilations were more of a challenge than they thought it would be and that more practice meant a higher comfort level,” said Ms. Rebholz.
Lastly, RQI has also proven to have some marketing and recruitment benefits for IVCH. The hospital shared the innovative training program with the community via articles in the local newspaper and Healthscene, the hospital’s newsletter. “RQI makes it easier to recruit the best staff because they understand the importance of embracing best practices. It means a lot to the community too because they understand that this improves care – we are the only ones doing this in our marketplace. It makes us stand out.”