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Official 2020 American Heart Association Guidelines for CPR and ECC Releasing October 2020

The American Heart Association recently announced that the official 2020 American Heart Association Guidelines for CPR & Emergency Cardiovascular Care (2020 AHA Guidelines for CPR & ECC) will be published online on Wednesday, October 21, 2020.

We understand that as healthcare providers, you need to be instantaneously prepared and effective in cardiac arrest emergencies as we continue to face the ongoing COVID-19 pandemic.

As you serve on the front lines of saving lives, and in this unprecedented time of physical distancing, the way you deliver CPR and ECC training is evolving. As we work toward the October publication, we are closely working with the American Heart Association evaluating the implications of the new Guidelines on the way we deliver information and training to improve cardiac arrest survival and outcomes – and the impact it has on your hospitals and health systems.

The AHA’s committed to resuscitation science and education

As the global source of the official resuscitation science and education guidelines used by training organizations, the AHA is moving forward with releasing 2020 Guidelines to ensure our hospitals are up-to-date on the very latest resuscitation science and education available.

Integrated directly with American Heart Association science, RQI Partners’ portfolio of digital solutions lead healthcare organizations on a journey to high-quality CPR performance and competence, maximizing lifesaving outcomes. To save more lives, healthcare providers, first responders, and lay rescuers must be competent in delivering high-quality CPR. Additionally, our resuscitation training and education helps patient care teams acquire the skills and knowledge they need to be competent as they work together to improve patient outcomes.

What 2020 AHA Guidelines materials will be released?

The American Heart Association will have the following materials available in English on October 21, with the launch of 2020 Guidelines:

  • All-new AHA Guidelines Website
  • 2020 AHA Guidelines for CPR and ECC Digital Reprint
  • Highlights of the 2020 AHA Guidelines for CPR and ECC (in 17 languages)
  • 2020 AHA Guidelines Science In-Service eLearning Course

We plan to share more information in the coming weeks as we feel it is important for our healthcare providers to remain informed about resuscitation science and education updated because we know that high-quality CPR is the primary component in influencing survival from cardiac arrest.

Our digital solutions provide safe, distanced CPR education through a cost-effective platform, unified seamlessly with American Heart Association science. In a changing world that is still evolving, our digital solutions offer comprehensive skills and cognitive CPR education that is safe, distanced, and tailored to the needs of each individual learner. View our mastery learning here.

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It takes a system: Thinking holistically about improving OHCA outcomes

When asked to picture the human body, what comes to mind? Most people don’t focus on a single component like a limb or an organ. Instead, they think holistically — looking at the body as an artfully designed system, where every component works in tandem to create life.

Ideally, we’d all have that same holistic “systems” viewpoint when tackling the overlooked epidemic known as out-of-hospital cardiac arrests:

  • An estimated 350,000 OHCAs annually in the U.S. alone
  • Between 70-90% of patients die before reaching a hospital
  • That’s 10x more deaths from opioid overdoses, auto fatalities or gun violence

Yet OHCA garners no headlines. No public outrage. No push for funding to end this unnecessary loss of life.

Why? In theory, because it’s a hard problem to solve.

You’ve likely heard of the “Chain of Survival” — the five links that improve a cardiac arrest victim’s chances of survival and recovery:

  1. Recognition of cardiac arrest and activation of the emergency response system
  2. Early CPR with an emphasis on chest compressions
  3. Rapid defibrillation
  4. Basic and advanced emergency medical services
  5. Advanced life support and post-cardiac arrest care

From a family member or bystander to a telecommunicator, EMT and hospital personnel, each link in the chain of survival can involve someone of widely varying knowledge and training. So, it’s difficult to think holistically when no single entity has accountability for every link in the chain. It’s human nature — we’re focused on playing our role to the best of our abilities rather than looking at the larger picture.

It takes a system to save a patient

Improving OHCA outcomes starts with a shift in thinking. Rather than focusing on individual links in the chain, it’s vital to start thinking in terms of systems: “How do we all work together to optimize our processes from start to finish?”

It’s been proven that survival rates in a community will improve if their EMS and PSAPs work together, have strong leadership, and foster a culture of excellence. In other words, forming a true end-to-end system.

When the Chain of Survival works seamlessly from beginning to end, an out-of-hospital cardiac arrest doesn’t have to be a death sentence. It can mean more years for 350,000 people to live, love and contribute to our world, and the end to a truly unnecessary public health epidemic.

Starting the process of improving OHCA outcomes

To reverse dismal survival rates, every community should be looking at ways to improve how they manage cardiac arrests. But where to begin? It all starts with data — understanding how effective your chain of survival is right now. We recommend first asking these six questions:

  1. What is our community’s Utstein survival percentage?
  2. How frequently do bystanders perform CPR?
  3. What is our time between 911 call and delivery of T-CPR?
  4. What is our department’s median compression fraction for CPR calls?
  5. How do our telecommunicators and EMS personnel train for cardiac arrest?
  6. How do we measure performance on cardiac arrest calls?

Once you’ve established a benchmark for your current performance, you can then identify and prioritize the areas that need improvement and begin the process of developing an effective quality improvement plan.

Bystander CPR rates are highest in communities where public safety answering points (PSAPs), or dispatch centers, provide telephone CPR (T-CPR) instructions.”

— Michael Christopher Kurz, MD, MS-HES, FACEP, FAHA, Chair of American Heart Association T-CPR Taskforce

Is your team operating within High-Performance Standards?

Start by taking the T-CPR Pulse Check. American Heart Association T-CPR Recommendations and Resources provides guidance to construct and maintain a science-based T-CPR program.

 Want to dive deeper into the science behind successful training and quality improvement initiatives?

Read the full AHA scientific statement or download the summary. Have questions on implementing a resuscitation quality initiative in your community? Ask an RQI expert — we are always here to help. Contact us for more information.

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Taking Ownership to Improve an Agency’s CPR Skills

Cardiac arrest survival rates vary widely across the country, but overall, these rates are dangerously low — as low as six percent for out-of-hospital cardiac arrests (OHCA).¹ Clearly, there is room for marked improvement.

The better the CPR, the better a patient’s chances of survival. But how does an agency know exactly how strong its CPR skills are — especially if there’s no mechanism in place to measure and improve?

That question drew Glori Strickler, EMS training coordinator for Matanuska Susitna Emergency Services in Palmer, Alaska, to the RQI Prehospital Healthcare Provider program. She explains, “MatSu is a very diverse agency with varying levels of staff experience. There was ‘tribal knowledge’ in our organization that our providers possessed excellent CPR skills, which was proven not to be the case.”

MatSu’s CPR fraction numbers were in the single digits; team members also lacked the assurance to direct others on critical CPR instruction. There were no interventions in place to boost their performance, and consequently, lives were hanging in the balance.

When it came time to renew MatSu’s traditional two-year BLS, PALS and ALS training — and the expenses associated with those renewals — Strickler was prompted to look for more effective alternatives. “Employing an option we knew was inferior and inadequate to continue the status quo was senseless,” she says. “More importantly, the potential CPR improvement equated to lives saved.”

RQI Prehospital Healthcare Provider provides a high-reliability platform for simulation-based mastery learning, implemented through low-dose, high-frequency quality improvement sessions that measure and verify competence. For Strickler, it represented fresh thinking across several key areas:

  • Learners receive objective, real-time feedback through program’s skills sessions.
  • Fiscal responsibility. RQI began to look very affordable when judged against traditional, yet less effective, options.
  • Staff confidence. According to Strickler, “With an absence of clear roles and responsibilities and communication, even on routine calls, I believed RQI could provide structure and boost confidence in this basic, yet lifesaving, skill.”

MatSu launched its RQI Prehospital Healthcare Provider initiative in January 2017. The program had 100% leadership investment from the start, resulting in full staff participation. And for team members who believed they had been delivering solid CPR already, the results were a huge eye-opener, recalls Strickler.

She points to many benefits of adopting the program — some rather unexpected. “Within a few months, our CPR fraction on actual calls jumped from single digits to the 70th percentile, and now hover around 90% on average. ROSC rates have doubled since implementation. And team members now take ownership and confidently direct others, particularly our fire department colleagues.”

Best of all? “Our survival rates are finally starting to climb.”

With COVID-19 cases starting to appear across Alaska, Strickler especially appreciates how RQI Prehospital Healthcare Provider allows MatSu’s EMS workers and staff to maintain their CPR competence and ability to deliver high-quality CPR. “Our teams can adhere to social distancing, since the program essentially stands alone,” she explains.

Ready to help save more lives?

RQI Prehospital Healthcare Provider is the only program that provides a high-reliability platform for simulation-based mastery learning, through low-dose, high-frequency quality improvement sessions. Find out more.

¹ Berger, S., Survival From Out‐of‐Hospital Cardiac Arrest: Are We Beginning to See Progress?, Sep 2017, Journal of the American Heart Association; 6:e007469.

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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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2bcd4c758e29d05100dbb1a6833c4131-huge-2.

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.