Implementation of a Low-Dose, High-Frequency Cardiac Resuscitation Quality Improvement Program in a Community Hospital.

BACKGROUND: In 2015 the American Heart Association launched the Resuscitation Quality ImprovementⓇ (RQIⓇ) Program to address the urgent need to improve in-hospital cardiac arrest survival through a novel competency-based model for health care provider (HCP) cardiopulmonary resuscitation (CPR) training. This innovation differs from the traditional Basic Life Support (BLS) training model by providing self-directed, low-dose, high-frequency CPR skill activities with the objectives of skills mastery and retention. A program implementation study was conducted at the first hospital in the state of Illinois to adopt RQI in 2016. METHODS: The study was designed to evaluate implementation of the RQI program, CPR performance during RQI simulation sessions, and participant impressions at a community hospital. Quantitative data were evaluated based on psychomotor compression and ventilation performance. Quantitative and qualitative data were evaluated based on a perceptual CPR confidence and program satisfaction survey. RESULTS: Statistical analysis demonstrates significant improvement in HCPs' quarterly psychomotor CPR skill performance over a one-year period in first compression score, and first and highest ventilation score per quarterly session. The number of attempts to pass the ventilation skill session decreased between the first and fourth quarter. Survey results of HCPs' program perceptions 30 months post-RQI implementation indicate satisfaction with the RQI program and an increase in CPR skill confidence. CONCLUSION: Findings demonstrate that the RQI program for ongoing verification of BLS skill and knowledge provides improvements in HCPs' CPR psychomotor competence and confidence/satisfaction using an efficient and sustainable method at a community hospital.

Interventions to Improve Adherence to a Hypoglycemia Protocol.

Background.. A formal evidence-based hypoglycemia protocol and treatment algorithm were developed to provide safe and effective management of hypoglycemia throughout the hospital and to support organization goals to achieve blood glucose control. However, rechecking blood glucose 15 minutes after treatment for hypoglycemia, as outlined in the protocol, was challenging for the nursing staff. Education was delivered several times, and hypoglycemia badge reference cards were provided to reinforce the protocol. Nursing staff observed that hypoglycemia treatment took several minutes, so the recheck was set at 15-30 minutes from the time hypoglycemia was identified. Audits and staff reeducation were performed, but compliance remained low. Objective.. A pilot was conducted to compare two innovative interventions to improve adherence to the protocol. Methods.. To improve timely rechecks, two different interventions were tested. The first required patient care technicians (PCTs) to remain in the patient's room for the full 15 minutes after treatment to perform the recheck. The second incorporated the use of timers to remind PCTs and nurses to perform the recheck. Results.. The timer group had significantly higher compliance with hypoglycemia rechecks than the group staying in the patient's room (84 vs. 52%, P <0.0001). It is difficult for a PCT to remain in a patient's room for a full 15 minutes. Timers enabled nurses and PCTs to perform other tasks without missing the recheck time. After implementation, the hospital achieved 75% compliance with the recheck. Conclusion.. This project demonstrated that the use of timers can be an effective and efficient way to remind busy hospital staff to recheck a patient's blood glucose after hypoglycemia treatment.

Effects of education on nurse confidence and cardiac surgical glycemic control.

This research was conducted to (1) determine the relationship between nurses' confidence levels using an endocrine order set after educational interventions and experience and (2) measure glycemic control after cardiac surgery with the use of order sets. Findings showed that nurses' confidence increased with ongoing education and experience. Furthermore, tighter glycemic control was achieved on postoperative days 1 and 2, as the protocol was refined, and as the nurses became more comfortable with its use.