More Frequent Resuscitation Training with RQI Improves Outcomes
December 07, 2016
Right now, healthcare educators may be experiencing the same dilemma as playwrights as they make decisions about how to implement Resuscitation Quality Improvement (RQI). How will they communicate the science that makes it clear there is a new, better way to conduct CPR training?
What’s Driving the Transition to RQI?
In 2010, the 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 SCA survival-to-discharge rates from 19% to 38% by 2020.
Given the rapid decay of CPR skills, hospitals are left with a significant challenge—how to preserve resuscitation skills and ensure 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 and how can hospitals adapt to the more frequent training requirements?
RQI in Action
Recently HealthStream interviewed leaders from two different hospitals. Both have arrived at the same “destination,” but they had very different reasons for their journey. Both Illinois Valley Community Hospital (IVCH) in Peru, Illinois, and St. Anthony Regional Hospital and Nursing Home in Carroll, Iowa, have recently partnered with the AHA, Laerdal, and HealthStream to implement RQI and shared their stories with HealthStream.
Both have adopted RQI and the Simulation Station to help meet the new recommended training requirements. The Simulation Station is a mobile cart that contains everything needed for quarterly training—adult and infant Voice-Assisted Manikins (VAMs), bag-valve masks, and a tablet computer.
Renee Rebholz, IVCH’s Director of Education, recently shared her hospital’s experience with the implementationand introduction of RQI. Like most of her colleagues at small, rural hospitals, Rebholz works hard to insure that IVCH’s 700 employees receive the training and certifications that they need. She 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. The necessity of providing it on a more frequent basis seemed a daunting task.”
Overcoming Resuscitation Training Challenges
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. Additionally, one-on-one training was frequently necessary. More importantly, Rebholz also noticed something that the 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 that as we conducted our training.”
Katie Towers, Director, Education Services, and her colleague Mikala Landon, Clinical Resource Nurse, also shared their experiences with their recent implementation at St. Anthony. An effective solution for BLS and ACLS is essential for St. Anthony as both are work eligibility requirements for St. Anthony staff. The organization takes a hard line on this requirement but has also supported employees with regular access to classes (5 per month), instructors dedicated to CPR, and sessions of variable duration to accommodate students who need only competency validation versus those who need more in-depth instruction.
In short, St. Anthony had a robust program for BLS and ACLS with great instructors and a regular program of classes that made access easy and convenient for staff. Their original process was efficient, cost-effective and met their needs.
“Science Too Compelling to Ignore”
One organization found it a constant challenge to maintain up-to-date CPR cards and felt as if the process was broken; the other had a well-oiled program that they felt worked well for their staff. Both were meeting the goal of keeping staff current on their resuscitation requirements. However, when they were introduced to the RQI program, leaders at both organizations found the recent science to be far too compelling to ignore.
Towers was stunned when she learned that students really could develop motor memory and that this type of learning changed their practice and helped develop high-quality CPR skills. Landon added that the Voice-Assisted Manikins (VAMs) provide accurate and immediate feedback. “That was huge for us.” Landon also adds that an instructor visually watching compressions cannot necessarily confirm that the speed and depth of compressions is correct.
RQI Produces Results
While it is still too early to completely quantify clinical results (both hospitals began their programs 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. Rebholz shared that many nurses were actually shocked to learn that they had been doing compressions incorrectly. The VAM provides specific audio and visual feedback on hand position, compression rate and depth, and ventilation rate that an alternative CPR manikin simply cannot provide.
Towers emphasizes that this is a rigorous program. “Staff feel a sense of accomplishment once they finish the program because they have quantifiable evidence of their competency. We feel more confident too, because we now have a way to quantify this as well. We’ve seen dramatic and immediate results. You can see results when you observe even one student during one session. You can see a change in their competency and practice. This is a differentiator for hospitals to provide this kind of training.”
This blog post excerpts an article in the Q3 2016 issue of PX Advisor. Complete the form below to download the issue.