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COVID-19 Ventilator Reskilling Course Now Available

With the high demand for ventilator management in the acute care setting due to COVID-19, healthcare professionals are frequently being called to manage complex patients requiring ventilatory support. In some cases, these healthcare professionals may be unfamiliar with ventilation and may need a refresher course on their skills.

To assist with this potential knowledge gap, the American Heart Association and RQI Partners are offering a self-directed eLearning course to assist healthcare professionals improve knowledge and competence in mechanical ventilation skills.

This adaptive learning course allows participants to identify their skill level at the beginning of the course. As learners progress through the course, they are continuously measured on their level of knowledge based on knowledge checks and customized course content is delivered in areas where information is needed most.

The COVID-19 Ventilation Reskilling eLearning Course includes:

•    Respiratory Physiology
•    Basic Ventilator Functions
•    Ventilator Use and Goals of Care in Respiratory Failure

 
The list price for this course is $50.00 per learner, and upon successful completion, students receive a certificate of completion. You can purchase the course directly from the American Heart Association’s ShopCPR page.

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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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Staying Committed to Quality T-CPR During a Crisis

Cardiac arrests don’t stop during a pandemic. And we all know the statistic –— immediate bystander CPR can double or even triple a cardiac arrest victim’s chance of survival, and T-CPR could double the number of victims who get CPR from bystanders.

Telecommunicators need to be ready. But skills decay, hesitation and lack of confidence all contribute to delays in recognition of cardiac arrest and increased hands-to-chest time.

“COVID-19 has definitely changed things, for example the safety questions we now have to ask for the first responders,” says Antonella “Toni” Volpe, Support Service Captain for 911 Fire/EMS Communications in Charles County, Maryland. ‘Have you been in contact with anyone who has a confirmed case of COVID-19? Does the patient have a fever 100.4 or greater, Hot to the touch in room temperature? Chills? Trouble breathing or shortness of breath? Persistent coughing, sneezing or wheezing?’ The challenge is asking more questions while not delaying bystanders’ hands to chest.”

Fulfilling the commitment to saving more lives

T-CPR skills improvement can’t come to a halt during a crisis. But traditional classroom EMD training and continuing education are more complicated than usual in the age of COVID-19:

  • Classroom training may not allow for social distancing, creating exposure for staff
  • Training may be canceled due to building closures and stay-at-home orders
  • Required certifications and credentials may lapse due to lack of training

Volpe’s Charles County agency, which began implementing the RQI-Telecommunicator (RQI-T) quality improvement program in August 2019, has been able to continue its efforts despite the current COVID-19 crisis.

RQI-T meets the challenge of providing training and continuous resuscitation quality improvement, reducing the preventable harm caused by poor quality CPR, while addressing the significant challenges presented by the pandemic. Rather than the typical instructor-led group training, it leverages online, simulation-based learning in small doses, along with facilitated coaching and debriefing sessions.

Columbia County, Oregon’s 911 Communications District has had a similar experience with RQI-T, according to Operations Manager Lara Marzilli. “We had other training scheduled that was supposed to be classroom training, so we had to cancel. But we can continue with RQI-T because it can be done individually.”

For PSAPs concerned about the difficulty of implementing a quality improvement effort during the pandemic, Marzilli has some practical advice. “The RQI-T program hasn’t been disruptive to operations at all. If anything, I think our staff appreciates the ‘normalcy’ of continuing the program and seeing the trainer’s familiar face, hearing his voice. The routine of it is appreciated right now.”

Marzilli and Volpe note the positive feedback from their staff members taking part in the program. Says Volpe, “We’ve seen some great changes, some really positive changes. People are getting hands to chest more quickly. I’ve heard staff on the floor saying, ‘If they don’t say yes, you must compress.’ These observations are being made more quickly. And more lives have been saved in the process.”

Adds Marzilli, “In the beginning, people were nervous about doing the RQI-T scenarios. Now, they really appreciate the feedback — both the information itself and the way it’s delivered.”

RQI-T: Simplifying CPR quality improvement initiatives

As both agencies adjust to life during a pandemic, Volpe and Marzilli reflect on the positives RQI-T has made possible. “RQI-T has been a very good experience for us. Staff is appreciative of it,” according to Marzilli. “When I’m at a conference, staff from other centers will ask, ‘Hey, are you using RQI-T?’ and I tell them it’s been really, really positive for us. It’s something we’ll be continuing long-term.”

Adds Volpe, “The RQI-T program is something we really needed — and I’m glad we could continue without interruption during the pandemic.” She continues, “We’ve gotten into a comfortable rhythm. Even with changing state protocols, RQI has been able to incorporate updates very quickly so everything stays current.”

For more information on implementing a T-CPR quality improvement program, visit T-CPR.

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Resolving COVID-19 skills preparation needs: an example of leadership

John Mouw, of Baptist Health South Florida, oversees an organization of 12 hospitals and 50+ Ambulatory, UCC, Free Standing ER, and other healthcare facilities in South Florida. He shared how has lead his team to transition to a new resuscitation training environment using HeartCode .

“These are fluid times that require transitional leadership in all things and this pandemic has emphasized that fact in no uncertain terms for healthcare.”

“The interesting thing about the redirection of resources is that it demanded  the need for an impromptu resuscitation certification/retraining solution. Not to mention the training/certification needs for onboarding newly hired staff looking for BLS, ACLS, PALS, or NRP classes so they would be eligible for hire. At this point I am sure some are saying, ‘just get the nurses in there, we will worry about certifications later.’ To me, this is trading off one form of emergently needed skills for another where missing either puts a patient at risk.”

Mouw quickly initiated a few innovative actions to address his organization’s needs to safely stay current and competent during the pandemic. At Baptist, he is using a combination of self-directed learning, virtual assessments and a very limited scope of in-person sessions only when needed for those who have never been trained in BLS.

The majority will be assigned HeartCode Complete for online cognitive learning and autonomous BLS skills practice and assessment on the skills station. The ACLS/PALS mega codes will be one-on-one with an instructor in an isolated room separated by a one-way mirror to limit exposure. This training occurs at the Baptist Health South Florida Clinical Learning Center (CLC) Simulation Suite.

As our way of life is changing due to ongoing developments in the COVID-19 pandemic, these self-directed digital learning programs give providers and administrators the ability to stay safe, competent and prepared.

Along with our parent organizations – the American Heart Association, Laerdal Medical – we are committed to delivering COVID-19 resources to ensure providers keep their focus where it needs to be in this moment: helping people and protecting their own health and energy, while ensuring they remain competent for helping save lives through effective resuscitation skills. Please visit our COVID-19 resources destination.

To spread our gratitude and show our support to healthcare providers, we’ve created posters you may download, print and display at your organization. You can access these posters on the COVID-19 resources page. We’re committed to helping your teams stay safe, competent and prepared.

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A message from our Vice President, Strategic Research and Innovation, Russell Griffin

To address the significant challenges of providing resuscitation in the age of COVID-19, the American Heart Association has launched a new online, adaptive learning course to coincide with the recently released Scientific Statement, “Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates with Suspected or Confirmed COVID-19.”

This course is a complimentary offering with critical information, clinical guidance, and modified algorithms from the AHA for BLS, ACLS and PALS during the COVID-19 pandemic. We encourage all healthcare providers to complete this course to enable understanding of how to apply the AHA’s interim guidance for the treatment of cardiac arrest victims with suspected or confirmed COVID-19. It can be accessed through a range of electronic devices and platforms including PCs and mobile devices.

This course is another means to deliver on our commitment to support healthcare providers in helping people while protecting their own health and energy, and ensuring they remain competent in lifesaving efforts through effective resuscitation skills.

New CPR COVID-19 Reference

Another new resource, “5 Things Every Healthcare Provider Should Know About CPR for COVID-19 Patients” is available as a downloadable quick reference to reinforce the key points of the Scientific Statement for your provider staff.

In the days and months ahead, we stand ready to assist you to stay safe, healthy and prepared.

Sincerely,


Russell Griffin MBA, LP
Strategic Research and Innovation
RQI Partners, LLC

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COVID-19 guidance and online course update from our COO, Brian Eigel

As the COVID-19 crisis continues to unfold, we’re listening and learning, and committed to helping all within our healthcare community on the front lines helping save lives. I’m contacting you today to share a new Scientific Statement, an online learning module and a library of resources to address some of your urgent concerns.

Earlier today, to address the challenges of providing resuscitation in the setting of the COVID-19 global pandemic and to balance the immediate needs of the victims with the provider’s safety, the American Heart Association released a Scientific Statement: Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates with Suspected or Confirmed COVID-19.

A new online adaptive learning course, developed to support and coincide with the release of the Scientific Statement, will enable healthcare providers to understand how to apply interim guidance to treat cardiac arrest victims with suspected or confirmed COVID-19. This complementary eLearning course: Interim Guidance for Resuscitation of Patients With Suspected or Confirmed COVID-19 can be viewed on desktop, laptop, mobile device or through a learning management system, and is available for download.

Saving Lives Safely
Along with our parent organizations – the American Heart Association, Laerdal Medical – and our partners at the Resuscitation Academy Foundation – we are committed to delivering COVID-19 resources to ensure providers keep their focus where it needs to be in this moment: helping people and protecting their own health and energy, while ensuring they remain competent for helping save lives through effective resuscitation skills. You can access these resources and new guidance on our COVID-19 Support page. Please use them freely with all of your colleagues.

We’re thankful for the valiant efforts you and your fellow healthcare professionals continue to provide and are privileged to have this opportunity to be of service.

Sincerely,


Brian Eigel, Ph.D.
Chief Operating Officer
RQI Partners, LLC