This blog post is based on a webinar featuring Nicole Kupchik, MN, RN, CCNS, CCRN, PCCN-CMC, a Critical Care Clinical Nurse Specialist who is also a well-respected, nationally and internationally-recognized speaker on a variety of emergency and critical care topics.
The Importance of Surveillance and Early Intervention
There is now an increased focus on the importance of surveillance and prevention in the inpatient setting. Kupchik stresses the importance of identifying at-risk patients before they have cardiac arrests and points to the value of early interventions such as rapid response teams and other programs in preventing in-hospital cardiac arrest. Citing research that shows that 80% of all cardiac arrest patients have abnormal vital signs before the event, she says that “really, any cardiac arrest outside of the ICU should be seen as an extraordinary event—it should not be seen as normal.” She goes on to say that patients tell us with their vital sign changes eight hours before cardiac arrest that they are deteriorating.
Measurement-Based Feedback Improves Performance
Kupchik is a passionate advocate for post-event feedback and evaluation. Voice-Activated Manikins (VAMs) provide this kind of feedback as part of quarterly exercises, but that doesn’t mean that the feedback can only happen during training. She encourages brief feedback sessions to look at the data from the defibrillator to provide objective information that can lead to changes in practice and ultimately to high quality CPR. “Regardless of what defibrillator you have in your hospital, you have the capability to do this,” says Kupchik. She also encourages the use of CPR report cards to put this data directly into the hands of providers.
While VAMs and even the defibrillators that we are using may help improve performance by providing feedback, Kupchik is also an advocate for even the simplest of ways to improve CPR performance. “One crazy, easy thing to do is to download a metronome app or use the one that is on your defibrillator in order to get an auditory cue. Getting that auditory cue is fascinating in codes because many people think that we should be compressing way faster than the recommended rate.”
There are also other devices that provide immediate feedback on compression depth, rate, and recoil. Sensors are built into the pads of many defibrillators and the feedback can be used to modify performance during the actual event. The defibrillator then wirelessly sends a report to a database that can be downloaded and provided to the team at any point following the event.
Chest compression fraction is another significant determinant in survival rates. The current goal is that providers be performing compressions 60% of the time during CPR, and Kupchik cites high-performing organizations and EMS systems that are actually trying to be at 90%. Kupchik urges providers to remember “if you are not compressing, they are not getting perfused.”