News | Sudden Cardiac Arrest | December 09, 2021

Hospital Initiative Reduced Time to First Shock for In-Hospital Cardiac Arrests

Article in Critical Care Nurse details how Orlando Health used hands-on simulation, online education to standardize response to code events

Orlando Health used a hands-on simulation and online education to standardize response to code events and reduce time to first shock for sudden cardiac arrest. Getty Images

Orlando Health used a hands-on simulation and online education to standardize response to code events and reduce time to first shock for sudden cardiac arrest. Getty Images


December 9, 2021 — During in-hospital cardiac arrests, responding quickly and confidently to code events requires a cohesive team, clearly defined roles and timely defibrillation.

“Using Simulation to Improve Adherence to Get With The Guidelines Time to First Shock” details how Orlando Health, Florida, improved the timely use of defibrillation and empowered nurses to confidently respond during code events. The article is published in the December issue of Critical Care Nurse (CCN), the journal of the American Association of Critical-Care Nurses.[1]

Time to first shock is one of four achievement metrics recognized in the American Heart Association’s Get With The Guidelines (GWTG) resuscitation program. The guidelines say hospitalized patients exhibiting ventricular fibrillation or pulseless ventricular tachycardia should receive defibrillation within two minutes to improve outcomes.

The initiative was a response to discovering that the facility was 99% compliant or perfect with three of GWTG’s four metrics in 2018, but only 42% successful with administering the first shock in a timely manner. Further analysis revealed the intensive care unit (ICU) reported the highest number of delays in time to first shock beyond the two-minute window, which is called a fallout. It also lacked a standard process for managing code events.

Data for the following year found the time to first shock metric improved to 83%, with further improvement to 100% during the first six months of 2020.

Author Andrea Paddock, MSN, APRN, ACCNS-AG, CCRN, is a clinical nurse specialist in the cardiac progressive care unit, Dr. P. Phillips Hospital, Orlando Health.

“When seconds count, it’s important for everyone to instantly know their role as part of the response team, which can change for each code situation,” she said. “This project helped our hospital improve compliance with GWTG metrics and enhance our care for patients experiencing cardiopulmonary arrests. It’s become a foundation for code simulations and mock code education throughout the hospital.”

The project began with nurses and ICU physicians collaborating to develop a diagram of a patient room that identified primary and secondary roles for specific team members and defined the number of staff needed to respond to a cardiopulmonary arrest.

A mock code simulation video was created and embedded in online education to demonstrate the proper role designations and execution displayed in the diagram.

All 40 ICU nurses were assigned to complete the new online education, which included electrocardiogram recognition and code documentation. The ICU learning specialist then worked one-on-one with individual nurses as needed.

The initiative then moved to structured code simulations, which included a pre-simulation discussion, three rapid-cycle simulations followed by a short debriefing, and a final conclusive debriefing at the end of the two-hour training session. The same scenario was used for each simulation, but participants were assigned to different roles, including the position of code leader, each time. 

“A pre-simulation discussion and slow code walk-through were crucial elements to equipping participants with the knowledge to respond more appropriately during the simulation and translate that knowledge into practice,” Paddock said.

In addition to the initial evaluation survey, a post-intervention questionnaire was sent three months after the simulation to assess how the training had impacted participants’ knowledge, confidence and overall clinical practice. 

Access the article. 

Find more sudden cardiac arrest content

 

Reference:

1. Andrea Paddock. Using Simulation to Improve Adherence to Get With the Guidelines Time to First Shock. Crit Care Nurse (2021) 41 (6): 62–68. https://doi.org/10.4037/ccn2021596.

 

Related Content

News | Sudden Cardiac Arrest

May 13, 2022 — The MemorialCare Heart & Vascular Institute at Long Beach Medical Center has been designated the only ...

Home May 13, 2022
Home
News | Sudden Cardiac Arrest

May 5, 2022 – A new Yale-led study has for the first time identified which risk factors are more likely to trigger a ...

Home May 05, 2022
Home
News | Sudden Cardiac Arrest

April 19, 2022 – Vesicles secreted from human heart cells may repair damaged tissue and prevent lethal heart rhythm ...

Home April 19, 2022
Home
News | Sudden Cardiac Arrest

March 30, 2022 — Clinician-scientists in the Smidt Heart Institute at Cedars-Sinai developed a clinical algorithm that ...

Home March 30, 2022
Home
News | Sudden Cardiac Arrest
March 11, 2022 – Patients who survive a heart attack together with sudden cardiac arrest are at increased risk of dying ...
Home March 11, 2022
Home
Feature | Sudden Cardiac Arrest | By Adam Power, M.D.

Out-of-hospital cardiac arrest (OHCA) continues to be overwhelmingly fatal despite cardiopulmonary resuscitation (CPR) ...

Home January 14, 2022
Home
News | Sudden Cardiac Arrest

September 13, 2021 — Early coronary angiography in out-of-hospital cardiac arrest (OHCA) patients without ST-segment ...

Home September 13, 2021
Home
Feature | Sudden Cardiac Arrest

September 1, 2021 — The world’s first feasibility study has found that drones can be used to deliver life-saving ...

Home September 01, 2021
Home
Feature | Sudden Cardiac Arrest

May 19, 2021 — A subgroup of patients who experienced an out-of-hospital cardiac arrest (OHCA) that did not respond to ...

Home May 19, 2021
Home
News | Sudden Cardiac Arrest

May 17, 2021 — In patients receiving therapeutic hypothermia after suffering out-of-hospital cardiac arrest, those who ...

Home May 17, 2021
Home
Subscribe Now