Development of a “First Five Minutes” Program to Improve Staff Response to Pediatric Codes

Background Delayed or inadequate cardiopulmonary resuscitation during cardiopulmonary arrest is associated with adverse resuscitation outcomes in pediatric patients. Therefore, a “First Five Minutes” program was developed to train all inpatient acute care nurses in resuscitation skills. The program focused on steps to take during the first 5 minutes. Objective To improve response of bedside personnel in the first few minutes of a cardiopulmonary emergency. Methods A simulation-based in situ educational program was developed that focused on the components of the American Heart Association’s “Get With the Guidelines” recommendations. The program was implemented in several phases to improve instruction and focus on necessary skills. Results The program garnered positive feedback from participants and was deemed helpful in preparing nurses and other staff members to respond to a patient in cardiopulmonary arrest. Time to chest compressions improved after training, and postintervention responses to questions regarding future code performance indicated participant recognition of the priority of the interventions addressed, such as backboard use, timely initiation of chest compressions, and timely administration of medications. Preliminary data show staff improvements in mock code performance. Conclusions The First Five Minutes program has proved to be a successful educational initiative and is expected to be continued indefinitely, with additional phases incorporated as needed. A rigorous study on best teaching methods for the program is planned.

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In reference to, “A focused investigation of expedited, stack of three shocks versus chest compressions first followed by single shocks for monitored ventricular fibrillation/ventricular tachycardia cardiopulmonary arrest in an in-hospital setting”

Journal of Hospital Medicine ◽

10.1002/jhm.2640 ◽

2016 ◽

Vol 11 (12) ◽

pp. 894-894

Author(s):

John A. Stewart

Keyword(s):

Ventricular Tachycardia ◽

Ventricular Fibrillation ◽

Cardiopulmonary Arrest ◽

Hospital Setting ◽

Chest Compressions

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Simulated airway drills as a tool to measure and guide improvements in endotracheal intubation preparation in the paediatric emergency department

BMJ Simulation and Technology Enhanced Learning ◽

10.1136/bmjstel-2020-000810 ◽

2021 ◽

pp. bmjstel-2020-000810

Author(s):

Kei U Wong ◽

Isabel Gross ◽

Beth L Emerson ◽

Michael P Goldman

Keyword(s):

Emergency Department ◽

Endotracheal Intubation ◽

Preparation Process ◽

High Stakes ◽

Paediatric Emergency Department ◽

Staff Members ◽

Paediatric Emergency ◽

Simulation Based ◽

Airway Equipment

IntroductionEmergent paediatric intubation is an infrequent but high-stakes procedure in the paediatric emergency department (PED). Successful intubations depend on efficient and accurate preparation. The aim of this study was to use airway drills (brief in-situ simulations) to identify gaps in our paediatric endotracheal intubation preparation process, to improve on our process and to demonstrate sustainability of these improvements over time in a new staff cohort.MethodThis was a single-centre, simulation-based improvement study. Baseline simulated airway drills were used to identify barriers in our airway preparation process. Drills were scored for time and accuracy on an iteratively developed 16-item rubric. Interventions were identified and their impact was measured using simulated airway drills. Statistical analysis was performed using unpaired t-tests between the three data collection periods.ResultsTwenty-five simulated airway drills identified gaps in our airway preparation process and served as our baseline performance. The main problem identified was that staff members had difficulty locating essential airway equipment. Therefore, we optimised and implemented a weight-based airway cart. We demonstrated significant improvement and sustainability in the accuracy of obtaining essential airway equipment from baseline to postintervention (62% vs 74%; p=0.014), and postintervention to sustainability periods (74% vs 77%; p=0.573). Similarly, we decreased and sustained the time (in seconds) required to prepare for a paediatric intubation from baseline to postintervention (173 vs 109; p=0.001) and postintervention to sustainability (109 vs 103; p=0.576).ConclusionsSimulated airway drills can be used as a tool to identify process gaps, measure and improve paediatric intubation readiness.

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Abstract 15595: Improved Clinical Performance and Teamwork of Pediatric Interprofessional Resuscitation Teams With a Simulation-Based Educational Intervention

Circulation ◽

10.1161/circ.132.suppl_3.15595 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Elaine Gilfoyle ◽

Deanna Koot ◽

John Annear ◽

Farhan Bhanji ◽

Adam Cheng ◽

...

Keyword(s):

Educational Intervention ◽

Strong Correlation ◽

Clinical Performance ◽

Team Training ◽

Chest Compressions ◽

Team Members ◽

Pediatric Resuscitation ◽

Time To Initiation ◽

Simulation Based ◽

Resuscitation Team

Introduction: Human errors occur during resuscitation despite individual knowledge of resuscitation guidelines. Poor teamwork has been implicated as a major source of such error; therefore interprofessional resuscitation teamwork training is essential. Hypothesis: A one-day team training course for pediatric interprofessional resuscitation team members improves adherence to PALS guidelines, team efficiency and teamwork in a simulated clinical environment. Methods: A prospective interventional study was conducted at 4 children’s hospitals in Canada with pediatric resuscitation team members (n=300, 51 teams). Educational intervention was a one-day simulation-based team training course involving interactive lecture, group discussions and 4 simulated resuscitation scenarios followed by debriefing. First scenario of the day was conducted prior to any training. Final scenario of the day was the same scenario, with modified patient history. Scenarios included standardized distractors designed to elicit and challenge specific teamwork behaviors. Primary outcome measure was change (before and after training) in adherence to PALS guidelines, as measured by the Clinical Performance Tool (CPT). Secondary outcome measures: change in times to initiation of chest compressions and defibrillation; and teamwork performance, as measured by the Clinical Teamwork Scale (CTS). Correlation between CPT and CTS scores was analyzed. Results: Teams significantly improved CPT scores (67.3% to 79.6%, P< 0.0001), time to initiation of chest compressions (60.8 sec to 27.1 sec, P<0.0001), time to defibrillation (164.8 sec to 122.0 sec, P<0.0001) and CTS scores (56.0% to 71.8%, P<0.0001). Significantly more teams defibrillated under AHA target of 2 minutes (10 vs. 27, P<0.01). A strong correlation was found between CPT and CTS (r=0.530, P<0.0001). Conclusions: Participation in a simulation-based team training educational intervention significantly improved surrogate measures of clinical performance, time to initiation of key clinical tasks, and teamwork during simulated pediatric resuscitation. A strong correlation between clinical and teamwork performance suggests that effective teamwork optimizes clinical performance of resuscitation teams.

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Abstract 325: Resuscitation Practices in Pediatric Hospitals: Insights From Get with the Guidelines-Resuscitation

Circulation ◽

10.1161/circ.142.suppl_4.325 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Jesse L Chan ◽

Yuanyuan Tang ◽

Joan S Roberts ◽

Paul S Chan

Keyword(s):

Chest Compression ◽

Pediatric Patients ◽

National Registry ◽

Chest Compressions ◽

Free Standing ◽

Pediatric Hospitals ◽

Adults And Children ◽

Get With The Guidelines ◽

Mock Codes ◽

Hospital Cardiac Arrest

Background: Resuscitation practices for adult in-hospital cardiac arrest (IHCA) vary widely, based on setting and size. Resuscitation practices in pediatric hospitals have not been examined in detail, and whether practices differ between free-standing pediatric hospitals and combined hospitals (which care for adults and children) is unknown. Methods: We conducted a survey of U.S. hospitals that submit data on pediatric IHCA to GWTG-Resuscitation, a large national registry of IHCA, to elicit detailed information on resuscitation practices. Hospitals were categorized as free-standing pediatric hospitals and combined hospitals, and rates of resuscitation practices were compared. Results: A total of 33 hospitals with at least 5 IHCA events between 2015-2019 completed the survey, of which 9 (27.3%) were freestanding pediatric hospitals and 24 (72.7%) were combined hospitals. Overall, 18 (54.5%) hospitals used a device to measure chest compression quality, 2 (6.1%) used a mechanical device to deliver chest compressions, 6 (18.2%) routinely monitored diastolic pressures during resuscitations, 16 (48.5%) had a staff member monitor chest compression quality, 10 (30.3%) used lanyards or hats to designate leaders during a resuscitation, 16 (48.5%) routinely conducted immediate code debriefings, and 7 (21.2%) conducted mock codes at least quarterly and 17 (51.5%) reported no set schedule. Freestanding pediatric hospitals were more likely to employ a device to measure chest compressions (88.9% vs. 41.7%; P=0.016), conduct code debriefing always or frequently after resuscitations (77.8% vs. 37.5%, P=0.044), use lanyards or a hat to designate the code team leader during resuscitations (66.7% vs. 16.7%, P=0.006), and allow nurses to defibrillate using an AED (77.8% vs. 29.2%, P=0.01). There were no differences in simulation frequency or other resuscitation practices between the 2 hospital groups. Conclusions: Across hospitals caring for pediatric patients, substantial variation exists in resuscitation practices. For some resuscitation practices, there were differences between freestanding pediatric hospitals and hospitals which care for both adults and children.

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Prolonged Chest Compressions during Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest due to Acute Pulmonary Embolism

Texas Heart Institute Journal ◽

10.14503/thij-14-4267 ◽

2015 ◽

Vol 42 (2) ◽

pp. 136-138 ◽

Cited By ~ 9

Author(s):

Carla Nobre ◽

Boban Thomas ◽

Luis Santos ◽

João Tavares

Keyword(s):

Pulmonary Embolism ◽

Thrombolytic Therapy ◽

Acute Pulmonary Embolism ◽

Cardiopulmonary Arrest ◽

Hemodynamic Instability ◽

Circulatory Support ◽

Chest Compressions ◽

Output State ◽

Dismal Prognosis ◽

Systemic Thrombolytic Therapy

Patients with hemodynamic collapse due to acute pulmonary embolism have a dismal prognosis if not treated rapidly. Therapeutic options include systemic thrombolytic therapy, rheolytic thrombectomy, and surgical embolectomy. However, the efficacy of thrombolytic therapy is diminished because the low-output state hinders effective delivery of the lytic agent to the thrombus. In the absence of any form of mechanical circulatory support, such as extracorporeal membrane oxygenation or cardiac surgery on site, we think that prolonged vigorous manual compressions might be the only way to support the circulation during the initial critical state, when thrombolytic therapy has been administered. We report the results of prolonged manual chest compressions (exceeding 30 minutes) on 6 patients who received tenecteplase in treatment of acute pulmonary embolism that induced in-hospital cardiopulmonary arrest. Four of 6 patients survived and were discharged from the hospital. In an era of increasing technologic complexity for patients with hemodynamic instability, we emphasize the importance of prolonged chest compressions, which can improve systemic perfusion, counteract the prothrombotic state associated with cardiopulmonary arrest, and give the lytic agent time to act.

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General Management Principles of the Pregnant Woman

Seminars in Respiratory and Critical Care Medicine ◽

10.1055/s-0037-1602167 ◽

2017 ◽

Vol 38 (02) ◽

pp. 123-134

Author(s):

Margaret Miller ◽

Amanpreet Kaur

Keyword(s):

Cardiopulmonary Arrest ◽

Patient Positioning ◽

Signs And Symptoms ◽

Diagnostic Procedures ◽

Pregnant Patient ◽

Physiological Changes ◽

Limited Data ◽

Chest Compressions ◽

General Management ◽

In Pregnancy

AbstractPregnancy is a dynamic process that consists of profound physiological changes mediated by hormonal, mechanical, and circulatory pathways. Understanding of changes in physiology is essential for distinguishing abnormal and normal signs and symptoms in a pregnant patient. These physiological changes also have important pharmacotherapeutic considerations for a pregnant patient. Although there are limited data to guide decisions regarding medications and diagnostic procedures in pregnancy, a careful review of risks should be balanced with review of risk of withholding a medication or procedure. Interventional pulmonary procedures can be safely performed in pregnant women while keeping in mind the maternal anatomic and physiologic changes. Furthermore, management of a maternal cardiopulmonary arrest requires important modifications in patient positioning and intravenous access to ensure adequate efficacy of chest compressions, circulation, and airway management. This review will provide an overview of maternal physiologic changes with a focus on cardiopulmonary physiology, pharmacotherapeutic considerations, diagnostic and interventional pulmonary procedures during pregnancy, and cardiopulmonary resuscitation in pregnancy.

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A Framework for Determining the Return on Investment of Simulation-Based Training in Health Care

INQUIRY The Journal of Health Care Organization Provision and Financing ◽

10.1177/0046958016687176 ◽

2017 ◽

Vol 54 ◽

pp. 004695801668717

Author(s):

Hatim Bukhari ◽

Pamela Andreatta ◽

Brian Goldiez ◽

Luis Rabelo

Keyword(s):

Health Care ◽

Return On Investment ◽

Cardiopulmonary Arrest ◽

Medical Center ◽

Academic Medical Center ◽

Tertiary Care ◽

Survival Rates ◽

Wide Range ◽

Simulation Based

This article describes a framework that has been developed to monetize the real value of simulation-based training in health care. A significant consideration has been given to the incorporation of the intangible and qualitative benefits, not only the tangible and quantitative benefits of simulation-based training in health care. The framework builds from three works: the value measurement methodology (VMM) used by several departments of the US Government, a methodology documented in several books by Dr Jack Phillips to monetize various training approaches, and a traditional return on investment methodology put forth by Frost and Sullivan, and Immersion Medical. All 3 source materials were adapted to create an integrated methodology that can be readily implemented. This article presents details on each of these methods and how they can be integrated and presents a framework that integrates the previous methods. In addition to that, it describes the concept and the application of the developed framework. As a test of the applicability of the framework, a real case study has been used to demonstrate the application of the framework. This case study provides real data related to the correlation between the pediatric patient cardiopulmonary arrest (CPA) survival rates and a simulation-based mock codes at the University of Michigan tertiary care academic medical center. It is important to point out that the proposed framework offers the capability to consider a wide range of benefits and values, but on the other hand, there are several limitations that has been discussed and need to be taken in consideration.

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Using Simulation Education With Deliberate Practice to Teach Leadership and Resource Management Skills to Senior Resident Code Leaders

Journal of Graduate Medical Education ◽

10.4300/jgme-d-13-00271.1 ◽

2014 ◽

Vol 6 (3) ◽

pp. 463-469 ◽

Cited By ~ 13

Author(s):

Amanda R. Burden ◽

Erin W. Pukenas ◽

Edward R. Deal ◽

Douglas B. Coursin ◽

Gregory M. Dodson ◽

...

Keyword(s):

Resource Management ◽

Skill Acquisition ◽

Cardiopulmonary Arrest ◽

Deliberate Practice ◽

Senior Resident ◽

Initial Assessment ◽

Management Skills ◽

High Stakes ◽

Simulation Based ◽

Improved Performance

Abstract Background Cardiopulmonary arrests are rare, high-stakes events that benefit from using crisis resource management (CRM). Simulation-based education with deliberate practice can promote skill acquisition. Objective We assessed whether using simulation-based education to teach CRM would lead to improved performance, compared to a lecture format. Methods We tested third-year internal medicine residents in simulated code scenarios. Participants were randomly assigned to simulation-based education with deliberate practice (SIM) group or lecture (LEC) group. We created a checklist of CRM critical actions (which includes announcing the diagnosis, asking for help/suggestions, and assigning tasks), and reviewed videotaped performances, using a checklist of skills and communications patterns to identify CRM skills and communication efforts. Subjects were tested in simulated code scenarios 6 months after the initial assessment. Results At baseline, all 52 subjects recognized distress, and 92% (48 of 52) called for help. Seventy-eight percent (41 of 52) did not succeed in resuscitating the simulated patient or demonstrate the CRM skills. After intervention, both groups (n = 26 per group) improved. All SIM subjects announced the diagnosis compared to 65% LEC subjects (17 of 26, P = .01); 77% (20 of 26) SIM and 19% (5 of 26) LEC subjects asked for suggestions (P < .001); and 100% (26 of 26) SIM and 27% (7 of 26) LEC subjects assigned tasks (P < .001). Conclusions The SIM intervention resulted in significantly improved team communication and cardiopulmonary arrest management. During debriefing, participants acknowledged the benefit of the SIM sessions.

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Comparison of Pentax-AWS Airwayscope and Glidescope for Infant Tracheal Intubation by Anesthesiologists during Cardiopulmonary Arrest Simulation: A Randomized Crossover Trial

BioMed Research International ◽

10.1155/2015/190163 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 5

Author(s):

Shunsuke Fujiwara ◽

Nobuyasu Komasawa ◽

Sayuri Matsunami ◽

Daisuke Okada ◽

Toshiaki Minami

Keyword(s):

Cardiopulmonary Resuscitation ◽

Tracheal Intubation ◽

Endotracheal Intubation ◽

Crossover Trial ◽

Cardiopulmonary Arrest ◽

Intubation Time ◽

Chest Compressions ◽

Analog Scale ◽

Randomized Crossover Trial ◽

Better Than

Background. Recent guidelines for infant cardiopulmonary resuscitation emphasize that all rescuers should minimize interruption of chest compressions, even for endotracheal intubation. We compared the utility of the Pentax-AWS Airwayscope (AWS) with the Glidescope (GS) during chest compressions on an infant manikin.Methods. Twenty-four anesthesiologists with more than two years of experience performed tracheal intubation on an infant manikin using the AWS and GS, with or without chest compressions.Results. In GS trials, none of the participants failed without compressions, while three failed with compressions. In AWS trials, all participants succeeded regardless of chest compressions. Intubation time was significantly longer with chest compressions with the GS (P<0.05), but not with the AWS. Difficulty of operation on a visual analog scale (VAS) for laryngoscopy did not increase significantly with chest compressions with either the GS or the AWS, while the VAS for tube passage through the glottis increased with compressions with the GS, but not with the AWS.Conclusion. We conclude that in infant simulations managed by anesthesiologists, the AWS performed better than the GS for endotracheal intubation with chest compressions.

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