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False Bravado Or Lost Confidence – RQI Bridges The Gap – Lorna Dudzik, DNP, RN, APN, CNS, CEN

Current literature is rich with robust evidence that healthcare providers’ (HCPs) CPR skills decay within weeks to months after the traditional biennial model of BLS training/certification.1 What also decays, or falsely inflates, is not as obvious to measure or quantify, but equally important: HCPs CPR skill confidence, a quiet inner knowledge that one is capable.

Of course I’m capable of performing CPR; I’m always compliant with my two-year BLS certification.” Sound familiar?

There is a gross and precarious misconception regarding HCPs self-perceived confidence to perform high-quality CPR versus their actual skill performance – an insidious phenomenon of reality versus perception.

In a 2017 study of dental students trained in BLS within the two-year certification requirement, researchers discovered that despite the participants reporting a high level of BLS knowledge and skill confidence, their ability to perform BLS did not predict actual competence. As a result, the authors concluded that neither BLS knowledge or perceived self-efficacy is predictive of real competence.2 Certainly, the findings and conclusion of this study can translate to any discipline of HCPs (nurses, physicians, technicians, etc.) trained via the biennial BLS model.

A wide range of individual variances and levels of CPR skill confidence exists, but let’s focus on the polar ends of this spectrum.
On one side are the HCPs who acknowledge their loss of confidence and inadequacy to perform CPR during an in-hospital cardiac arrest (IHCA) event. This category of HCPs runs the other way when a “code blue” is called and consciously, or unconsciously, avoid jumping in to perform life-saving CPR.

On the opposite end are the HCPs who feel a sense of “false bravado”. This category of HCPs erroneously believes that simply because they are compliant within the two-year BLS certification requirement, they will undoubtedly perform high-quality CPR. However, research demonstrates otherwise. Numerous studies show that despite biennial BLS-compliance, HCP CPR skills often fail to meet the key AHA guideline metrics of compression and ventilation (correct compression fraction, recoil, depth, rate, hand placement, and ventilation volume, rate).1,3 Unfortunately, inflated false confidence does not compensate for poorly deflated CPR skill performance – a perilous combination.

Regardless of which side of the confidence spectrum the HCP resides, the effect will not only negatively impact vital CPR skill performance but also result in detrimental outcomes for the IHCA patient.

However, there is a solution. The Resuscitation Quality Improvement® (RQI®) Program.

In a recent comprehensive study at Illinois Valley Community Hospital (IVCH), the first hospital in Illinois to adopt RQI in 2016, researchers surveyed HCPs confidence levels as a result of participation in RQI two-and-a-half years post-implementation. The results were revealing and encouraging. One of the survey items asked HCPS to rate their ability to perform BLS prior to the RQI program via the biennial BLS model, on a confidence level five-point Likert scale of Strongly Agree to Strongly Disagree. The next item asked HCPs to rate their ability to perform BLS on the same Likert scale after participation in the RQI program.

One hundred thirty-two IVCH HCPs were surveyed. Two pre-post-RQI item results revealed increased confidence levels after participation in the RQI program, as follows:

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The number of responses for the combined categories of both Strongly agree and Agree demonstrated an improvement of confidence in HCPs’ ability to perform BLS after participating in the RQI program by a total of 19%.

Another survey item asked HCPs if their BLS skill performance will improve using the RQI in the future. The responses were overwhelmingly favorable with a 78% combined total for both Strongly Agree and Agree, as follows:

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Skills obtained using the RQI program will improve how I perform BLS in the future.
Frequency Percent Valid Percent Cumulative Percent
Valid Strongly agree 34 25.8 26.0 26.0
Agree 68 51.5 51.9 77.9
Neither agree or disagree 24 18.2 18.3 96.2
Disagree 5 3.8 3.8 100.0
Total 131 99.2 100.0
Missing             System
Total
1
132
.8
100.0

As early 2016 adopters of RQI, IVCH took a leap of faith and embraced the promise of this novel BLS training platform. The payoff proved to be positive and remarkable. In a recent article regarding analysis results of the RQI study at IVCH, Adam Cates highlighted the significant improvement in HCPs’ CPR compression/ventilation performance during RQI training sessions, an appreciable return on investment, and greater satisfaction with the RQI program compared to the traditional BLS model. Additionally, the HCP perceptual survey results also reflected higher CPR skill confidence due to RQI BLS training. Indeed, an overall win, win, and win.

In summary, the gap between CPR skill confidence and skill performance was bridged at IVCH due to the intentional design and objective of RQI. Consequently, the synergy of two crucial interwoven dynamics, competence and confidence, rose together to reach the ultimate end goal – to improve IHCA survival and outcomes.

For more information of the impact of RQI at IVCH, the study can be fully accessed in the
Joint Commission Journal of Quality and Patient Safety, titled: Implementation of a Low-Dose, High-Frequency Cardiac Resuscitation Quality Improvement Program in a Community Hospital. Authored by Lorna Rozanski Dudzik, DNP, RN, APN; Debra G. Heard, PhD; Russell E. Griffin, MBA, LP, FP-C; Mary Vercellino, MSN, RN, ACNS-BC, CWON; Amanda Hunt, MS, BSN, RN; Maureen Rebholz, EdD, MSN, RN; Adam Cates

This article was written by Lorna Dudzik, is Assistant Professor, College of Nursing and Health Sciences, Lewis University, Romeoville, Illinois, and AHA ACLS/BLS Instructor and Get With The Guidelines® Resuscitation Data Abstractor, Edward Hospital, Naperville, Illinois.

References
1. American Heart Association. Resuscitation quality improvement annotated bibliography. 2017. https://www.heart.org/idc/groups/heart-public/@wcm/@ecc/documents/downloadable/ucm_459991.pdf

2. Mac Giolla Phadraig C, Ho JD, Guerin S, et al. Neither Basic Life Support knowledge nor self‐efficacy are predictive of skills among dental students. European Journal of Dental Education. 2017;21:187-192.

3. Niles DE, Duval-Arnould J, Skellett S, et al. Characterization of Pediatric In-Hospital Cardiopulmonary Resuscitation Quality Metrics Across an International Resuscitation Collaborative. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2018;19:421-432.

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CPR in the age of social distancing

In today’s climate of social distancing to control the spread of coronavirus (COVID-19), self-directed education and training through Resuscitation Quality Improvement (RQI) and HeartCode Complete support continued CPR competence and preserve current safety protocols. Designed for individual learning, the programs allow providers to remain at the point of care and avoid the closeness of a classroom setting.

“Our technology platforms, simulation stations and solution delivery teams are fully available to health care systems during this critical time,” said Brian Eigel, Ph.D., chief operating officer of RQI Partners, a partnership between the American Heart Association and Laerdal Medical.

RQI Partners advises medical teams to follow the infection control protocols of their individual facilities and provides guidance from Laerdal Medical in “Basic Cleaning and Maintenance for RQI and HeartCode Complete Equipment and Stations.”

Laerdal Medical has a series of webinars available, “Helping Prepare Your Organization for Coronavirus (COVID-19),” for hospital health care teams to test and improve systems for infection control, personal protective equipment, and management of exposure to high-risk communicable respiratory illness.

RQI Partners is thankful to all healthcare providers for their unwavering commitment during this uncertain time as we all hope to help the health and well-being of people everywhere.

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The Importance of Data for Our Healthcare Future

Data, analysis and insights are crucial to improving healthcare outcomes. In resuscitation education, we are transitioning from traditional classroom-based education compliance models to highly evolved platforms that allow us to see and verify learner competence and organizational performance. Using data to measure and improve, we can verify learner competence, clinical performance and drive quality improvement to increase cardiac arrest survival. Read More >

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Keep Science on Your Side

Why do you take BLS, ACLS and PALS training? Is it because your employer requires you to do so? Is it because of The Joint Commission requirements for your hospital? Is it to make you more confident in your ability to save the life of a patient in cardiac arrest? All of the above?

Currently, the national average for in-hospital cardiac arrest survival to discharge is 26%. We know from Get with the Guidelines – Resuscitation data that there’s significant variability in resuscitation care across US hospitals: a patient’s odds for surviving a cardiac arrest varies by up to 42% depending on the hospital! While it is not clear what factors are creating this variability in care, high-quality CPR is the single biggest influence on cardiac arrest survival. Did you know a study published last year showed that AHA Guidelines-compliant CPR was only delivered 11% of the time during pediatric cardiac arrests? This reinforces the clinical knowledge versus performance gap that has been known since at least 2005, when two JAMA studies showed that both pre-hospital and in-hospital healthcare professionals were not routinely providing high-quality CPR during actual cardiac arrests.

Read More >

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Taking the High Road to High-Quality CPR

Every day, you work to provide the best quality and safest patient care, and to help your organization to run more smoothly and efficiently. Everything you do should align with these critical priorities, including your choice of a CPR education program for your organization. Science-based resuscitation education that has been proven to build competence in high-quality CPR is essential to saving lives of victims of cardiac arrest.

Hands down, the American Heart Association (AHA) is the leader in resuscitation education science. As a founding member council of the International Liaison Committee on Resuscitation (ILCOR) and the only United States member council, the AHA helps analyze global resuscitation research and develop treatment recommendations in their Guidelines for CPR & Emergency Cardiovascular Care.

When translating that science into their BLS, ACLS and PALS programs, and to even further ensure the success of resuscitation education, the AHA published the first-ever Resuscitation Education Scientific Statement, providing educational strategies to achieve resuscitation competence through mastery learning. These strategies, applied to the instructional design of AHA programs, increase true mastery of resuscitation knowledge and skills, leading to the delivery of high-quality CPR in a cardiac arrest emergency.

Alternative CPR training programs do not follow resuscitation science or educational science, and include options that only confuse the organizations and educators who are working to improve quality and survival outcomes, with issues including:

  • No established frequency in training
  • Critically important content can be skipped
  • Skills assessments with no objective measurement of components of high-quality CPR

Resuscitation education developed by the AHA and Laerdal Medical and delivered by RQI Partners, like HeartCode® and RQI ® , truly develops high-quality resuscitation competence within an organization like no other program can.

Please join my webinar on Tuesday, August 13 to learn more about structuring a program for competence: Resuscitation Competence: An Algorithm for Saving Lives.

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The Foundation and the Future of Resuscitation Care

Practice like you play is an oft-repeated phrase that coaches of many sports advise their athletes. Being prepared and practicing frequently for any event, from athletics to business to healthcare, will enable you to perform your best when the pressure is on.

For over 50 years, the American Heart Association has been the catalyst for improving heart health and reducing deaths from heart conditions and diseases, continuously innovating in pursuit of the advancement of medical science and transference of acquired knowledge to accelerate lifesaving. Learn more about innovations from the American Heart Association that lead to improved resuscitation care.

Because of this demonstrated leadership in evidence-based medical and educational science, healthcare providers rely on the American Heart Association Guidelines as the basis for clinical decision making for stroke, heart failure, resuscitation, atrial fibrillation, and coronary artery disease. No other organization is more knowledgeable or prepared to advise clinicians on cardiovascular conditions or the broad scope of resuscitation etiology or treatment.

But guidelines alone aren’t enough to keep healthcare providers competent in complex procedures like resuscitation. The science is clear: resuscitation skills degrade over three to six months, making it critically important to regularly refresh resuscitation psychomotor skills – practice is required to achieve the competence and confidence needed for the best possible patient care.

Healthcare institutions already rely on the American Heart Association as their main resource for heart guidelines-directed care – why look anywhere else for resuscitation training and quality improvement? Your staff should practice their skills using proven American Heart Association quality improvement solutions to ensure your healthcare providers are ready to provide the best possible patient care every day. The American Heart Association and Laerdal Medical formed a strategic alliance to leverage their unique strengths to co-create innovative solutions to help save more lives from cardiac arrest. Over the ensuing years, the American Heart Association and Laerdal have used their recognized leadership in resuscitation science, education and technology to develop multiple solutions that have helped train more than 15 million people to act during a cardiac arrest.

Programs delivered from RQI Partners, including RQI® 2020 and HeartCode®, prepare healthcare providers to master competence in high-quality CPR. There is no equal substitution for the proven quality of these American Heart Association programs or their efficacy in preparing the responder to save a life in an emergency.

If you want to hit a home run in the big game, you have to practice. If you want to save the life of a patient in cardiac arrest, you must provide and perform high-quality CPR. It is essential to practice how you perform, with the definitive leaders in resuscitation science and technology – you owe it to your staff and your patients.

Please join my webinar on Tuesday, August 13:  Resuscitation Competence: An Algorithm for Saving Lives.

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Celebrating Survival – RQI Recognizes CPR Week 2019

As CPR Week comes to a close, we’re sharing the stories of both cardiac arrest survivors and responders, and the profound impact that rapidly-administered CPR has had on their lives.

A bystander saved his coworker’s life after watching the “Hands-Only CPR” video, produced by the American Heart Association. The video inspired him to act and ultimately saved a life.

Read More >

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Know the Facts – RQI Recognizes CPR Week 2019

Sudden Cardiac Arrests occur every day. More often than you imagine. In the U.S., there are 559,000 cardiac arrests reported each year. This CPR and AED Awareness Week, lets recognize this incidence for what it is…a Public Health Crisis. Every day, thousands of people utilize their CPR skills to save lives; from bystanders to 911 operators to trained healthcare providers. Someone is alive today because of your knowledge and competence in CPR, and we are so grateful for your actions.

Our mission to eliminate preventable death from sudden cardiac arrest revolves around live-saving CPR, administered by people just like you. However, 70 percent of Americans may feel helpless to act during a cardiac emergency because they either do not know how to administer CPR, or their competence has significantly lapsed. Approximately 88 percent of cardiac arrests occur at home. Consequently, the life you save with CPR is mostly likely to be someone you love.

This CPR Week, and in light of this growing public health crisis, we are empowering healthcare providers, telecommunicators and bystanders to understand the impact they can have by utilizing CPR. For bystanders, that means performing immediate hands-only CPR, which you can learn about by watching this instructional video. Telecommunicators can guide others through saving a loved one’s life with High-Quality Telephone CPR, and healthcare provides can ensure that their CPR skills are verifiably competent, instead of merely compliant.

We all have the power to save lives; let’s equip ourselves with the right tools to do so.

Visit these links to learn how you can save a life with CPR:

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Nurses Week 2019

As Nurses Week continues, we salute and shine a spotlight on Nicole Morby, RN with Intermountain Healthcare in Salt Lake City for the lifesaving care she provides every day … in the hospital and her local community. Read further to learn more about her story.

My path to becoming a nurse took a couple twists and turns, but I eventually landed exactly where I was meant to be and am doing what gives me such a fulfilling purpose in life.

I wanted to work in the healthcare field my entire life. I started college as a chemistry major and pre-med student. Along the way, in my sophomore year, I discovered a love for public relations and event planning. So, I graduated with a degree in those disciplines and then followed my first passion, receiving a nursing degree a few years later.

For a little over five years now, I’ve been caring for patients, their families and the community at-large to ensure they attain, maintain or recover optimum health and quality of life. In order to deliver in this manner, I have to be certain that I’m providing the highest quality of patient care, which means staying abreast and remaining current on guidelines, patient and/or hospital protocol and training.

CPR is a core skill that nurses must possess and be able to confidently and competently perform when a patient suffers a cardiac arrest. Intermountain Healthcare, my employer since 2015, took a significant step in 2017 to ensure its nursing staff received the best CPR training through implementation of the Resuscitation Quality Improvement® (RQI®) program. And actually, RQI, which was co-developed by the American Heart Association and Laerdal Medical, is so much more than training; it is a quality improvement program that verifies CPR competency in 10-minute, simulated skills sessions every 90 days.

In my role as an operating room nurse, I’ve participated in the RQI program for about a year and a half. Although it is a requirement of my employment and prepares me to respond to in-hospital cardiac arrest, I recently was able to make a profound difference in a family’s life one Wednesday afternoon.

It was the start of the fourth quarter of 2018 and my RQI assignment was infant CPR. I tackled it early since the holidays were approaching, which is the busiest time in the operating room. One week later, I was having lunch with a friend at a fast food restaurant when a 3-month-old needed CPR. I responded calmly and took action. After the event was over, I continued eating my lunch as if nothing happened. My friend couldn’t believe the way I responded and was shocked that I returned to normal behavior. Throughout the day, I reflected on my friend’s reaction. It hit me! It was confidence that allowed me to respond and act so calmly and quickly. I was so grateful I completed my RQI skills session the week before, leaving infant CPR fresh on my mind.

A real-life event in the community is very different than in the operating room or on the hospital floor. I expect these situations at work; I am wearing my nurse hat and handling difficult circumstances every day. On that Wednesday afternoon, however, I was wearing my mom hat since my three children were with me. I was able to switch roles very quickly and smoothly, and with full confidence in my actions. I thank my hospital for giving me the confidence and ability to act by implementing the latest technology in CPR quality improvement.

While I still dabble in event planning periodically, nursing and caring for others ultimately became my career path. Saving that infant’s life confirmed that I made the right choice.

Nicole Morby, RN, Intermountain Healthcare (Salt Lake City)
Nicole Morby, RN, Intermountain Healthcare (Salt Lake City)
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RQI® and HeartCode® are Now HLC Validated

At the start of 2019, the American Heart Association and Laerdal Medical agreement with HealthStream became effective. This agreement provides HealthStream customers with access to the AHA and Laerdal co-developed Resuscitation Quality Improvement® program and range of HeartCode® BLS, ACLS and PALS eLearning programs on HealthStream’s Learning Center™ (HLC).

Today, we announce that the RQI® and HeartCode® resuscitation solutions are HLC-validated, meaning they meet the standards for high-quality delivery and integration with the HealthStream Learning Center. As a result of this HLC Validation, authorized users of both HealthStream and the RQI portfolio of programs may gain access to RQI programs, namely RQI and HeartCode, through the HLC.

Because we are committed to providing equitable and reliable access to our resuscitation program portfolio, RQI Partners have entered into agreements with several learning management platform organizations. With these new partnerships, we will further the reach of our competence-based resuscitation programs to equip providers with the competence to perform high-quality, lifesaving CPR on every patient and to improve operational performance in hospitals across the U.S.

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Expressing Gratitude This American Heart Month

In honor of American Heart Month, we’d like to express our gratitude to hospitals who trust American Heart Association programs to achieve the lifesaving mission we share.

“AHA is the standard everyone recognizes when it comes to evidence-based practice and research, and that’s something we wanted to be a part of.” –   AHA Training Center Read More >