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How to improve nurse competency

Understanding the Evolution of CPR Training in Non-Acute Care Settings

Even if it’s only a cursory review in order to qualify for recertification, CPR training is available in most healthcare settings. However, with the rise of more non-acute care facilities in the healthcare landscape, CPR training — or the lack thereof — has become a patient-safety issue.

Thanks to new and better training and technology, that shortfall is easily remedied, says Donna Haynes, a nurse and clinical educator who serves as HealthStream’s national resuscitation coach. With more than 3 decades’ worth of experience in the field, Haynes is able to drill down into specifics when working with organizations, as well as take the long view to assess where CPR training has been, how it’s evolving, and what it will look like going into the future.

First, the problem: According to statistics, Haynes says that the resuscitation rate for adult hospital patients is between 18 percent and 24 percent. As low as those numbers are, they plunge to 2 percent to 11 percent in non-acute care settings, and even those patients who survive an arrest are adversely affected by severe functional narrowing and other cardiac changes. So, Haynes says, there’s little debate about the need for more, and better, CPR training.

Non-acute settings are ground zero for change

“The non-acute settings are seeing a need because patient acuity is climbing, so they need to improve the resuscitation training,” she says. “The improvement is slow, but it’s coming. It’s beyond just getting that card. It’s really having your staff provide quality CPR, which means providing the compressions, the respirations, that will maintain that patient until other care intervention. The key is really to get our training to where we’re perfusing that patient because good perfusion until help arrives is what really turns and improves those outcomes.”

In addition to a sicker patient population, the non-acute care setting is crucial for CPR because of the continued expansion of non-hospitalized patient care. These facilities and care providers now include:

  • ambulatory care
  • outpatient clinics
  • rehabilitation facilities
  • home health
  • mental health
  • prisons
  • physician offices
  • dialysis centers
  • long-term care
  • assisted living
  • hospice
  • behavioral health centers

Whatever the surroundings, Haynes says that survival rates can be directly tied to training, the efficacy of which is entirely down to the provider, equipment used, and curriculum.

“Unfortunately, a lot of these non-acute settings will use third-party vendors to come in, teach the course, distribute the cards, and then they’re on their way. It’s really important that we look at what is the training they’re getting: is it objective, or is it subjective? An instructor can be subjective, with regards to what they feel you’re performing, vs. using manikins, which can give objective feedback and really improve the recall of that training in a real-time situation. One thing about these settings is that it’s not every day they’re having a code, so that makes it even more important to really hone the training so that there is a retention of learning.”

Complex acuities and different types of patients will always present a challenge to all types of care delivered in non-acute settings. Length of stay, less awareness of specific patient issues or concerns, and sometimes a lack of medical history are just some obstacles staff face. Now add to that the staff itself may experience high turnover, and that means that core services such as CPR must be frequently taught and updated, Haynes adds.

“No. 1 is, where was that staff member working before? What is their experience? Turnover has been high and continues to be high in some of those settings.” She says. “You provide your education and training, and then you get a whole another group, and you’ve got to do it again. So, I think it’s imperative that those responsible for that training keep a post on the turnover, the staff that’s there and have more frequent training and testing, such as mock codes where you practice responding to code situations. Do you have an annual skills fair, where staff works with resuscitation? Things of that nature keeps it in front of them. Keep those individuals working in the non-acute settings competent to respond at a high level, because they don’t see codes as much.”

About Donna Haynes:

Donna Haynes is a nurse and clinical educator who serves as HealthStream’s national resuscitation coach. Her results-oriented HeartCode programs meet the new American Hospital Association guidelines for Resuscitation Quality Improvement, making them a must for any organization committed to delivering quality patient care. Prior to joining HealthStream, Donna was a HeartCode user and administrator at Pullman Regional Hospital. Her healthcare career also has included roles as an emergency department, pediatric intensive care and medical surgical staff RN, Director of Clinical Education and Simulation and a Magnet Coordinator. She is a national award winner for her work in developing CPR competence.

This blog post is taken from a HealthStream Second Opinions Podcast that was recorded recently. To hear Haynes’ full discussion, click here.

 

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