Hospital employees' theoretical knowledge on what to do in an in-hospital cardiac arrest

<p>Abstract</p> <p>Background</p> <p>Guidelines recommend that all health care professionals should be able to perform cardiopulmonary resuscitation (CPR), including the use of an automated external defibrillator. Theoretical knowledge of CPR is then necessary.</p> <p>The aim of this study was to investigate how much theoretical knowledge in CPR would increase among all categories of health care professionals lacking training in CPR, in an intervention hospital, after a systematic standardised training. Their results were compared with the staff at a control hospital with an ongoing annual CPR training programme.</p> <p>Methods</p> <p>Health care professionals at two hospitals, with a total of 3144 employees, answered a multiple-choice questionnaire before and after training in CPR. Bootstrapped chi-square tests and Fisher's exact test were used for the statistical analyses.</p> <p>Results</p> <p>In the intervention hospital, physicians had the highest knowledge pre-test, but other health care professionals including nurses and assistant nurses reached a relatively high level post-test. Improvement was inversely related to the level of previous knowledge and was thus most marked among other health care professionals and least marked among physicians.</p> <p>The staff at the control hospital had a significantly higher level of knowledge pre-test than the intervention hospital, whereas the opposite was found post-test.</p> <p>Conclusions</p> <p>Overall theoretical knowledge increased after systematic standardised training in CPR. The increase was more pronounced for those without previous training and for those staff categories with the least medical education.</p

The impact of CPR and AED training on healthcare professionals' self-perceived attitudes to performing resuscitation

Background: Healthcare professionals have shown concern about performing mouth-to-mouth ventilation due to the risks to themselves with the procedure. However, little is known about healthcare professionals' fears and attitudes to start CPR and the impact of training. Objective: To examine whether there were any changes in the attitudes among healthcare professionals to performing CPR from before to after training. Methods: Healthcare professionals from two Swedish hospitals were asked to answer a questionnaire before and after training. The questions were relating to physical and mental discomfort and attitudes to CPR. Statistical analysis used was generalized McNemar's test. Results: Overall, there was significant improvement in 10 of 11 items, reflecting various aspects of attitudes to CPR. All groups of health care professionals (physicians, nurses, assistant nurses, and "others" = physiotherapists, occupational therapists, social welfare officers, psychologists, biomedical analysts) felt more secure in CPR knowledge after education. In other aspects, such as anxiety prior to a possible cardiac arrest, only nurses and assistant nurses improved. The concern about being infected, when performing mouth to mouth ventilation, was reduced with the most marked reduction in physicians (75%; P &lt; 0.001). Conclusion: In this hospital-based setting, we found a positive outcome of education and training in CPR concerning healthcare professionals' attitudes to perform CPR. They felt more secure in their knowledge of cardiopulmonary resuscitation. In some aspects of attitudes to resuscitation nurses and assistant nurses appeared to be the groups that were most markedly influenced. The concern of being infected by a disease was low

Occupational affiliation does not influence practical skills in cardiopulmonary resuscitation for in-hospital healthcare professionals

<p>Abstract</p> <p>Background</p> <p>D-CPR (Defibrillator Cardiopulmonary Resuscitation) is a technique for optimal basic life support during cardiopulmonary resuscitation (CPR). Guidelines recommend that healthcare professionals can perform CPR with competence. How CPR training and provision is organized varies between hospitals, and it is our impression that in Sweden this has generally improved during the last 15-20 years. However, some hospitals still do not have any AED (Automated External Defibrillators). The aim was to investigate potential differences in practical skills between different healthcare professions before and after training in D-CPR.</p> <p>Methods</p> <p>Seventy-four healthcare professionals were video recorded and evaluated for adherence to a modified Cardiff Score. A Laerdal Resusci Anne manikin in connection to PC Skill reporting System was used to evaluate CPR quality. A simulated CPR situation was accomplished during a 5-10 min scenario of ventricular fibrillation. Paired and unpaired statistical methods were used to examine differences within and between occupations with respect to the intervention.</p> <p>Results</p> <p>There were no differences in skills among the different healthcare professions, except for compressions per minute. In total, the number of compression per minute and depth improved for all groups (<it>P </it>< 0.001). In total, 41% of the participants used AED before and 96% of the participants used AED after the intervention (<it>P </it>< 0.001). Before intervention, it took a median time of 120 seconds until the AED was used; after the intervention, it took 82 seconds.</p> <p>Conclusion</p> <p>Nearly all healthcare professionals learned to use the AED. There were no differences in CPR skill performances among the different healthcare professionals.</p

In-Hospital Cardiac Arrest : A Study of Education in Cardiopulmonary Resuscitation and its Effects on Knowledge, Skills and Attitudes among Healthcare Professionals and Survival of In-Hospital Cardiac Arrest Patients

This thesis investigated whether out­come after in-hospital cardiac arrest patients could be improved by a cardiopulmonary resuscitation (CPR) educational intervention focusing on all hospital healthcare professionals. Annually in Sweden, approximately 3000 in-hospital patients suffer a cardiac arrest in which CPR is attempted, and which 900 will survive. The thesis is based on five papers: Paper I was a methodological study concluding in a reliable multiple choice questionnaire (MCQ) aimed at measuring CPR knowledge. Paper II was an intervention study. The intervention consisted of educating 3144 healthcare professionals in CPR. The MCQ from Paper I was answered by the healthcare professionals both before (82% response rate) and after (98% response rate) education. Theoretical knowledge improved in all the different groups of healthcare professionals after the intervention. Paper III was an observational laboratory study investigating the practical CPR skills of 74 healthcare professionals’. Willingness to use an automated external defibrillator (AED) improved generally after educa­tion, and there were no major differences in CPR skills between the different healthcare professions. Paper IV investigated, by use of a questionnaire, the attitudes to CPR of 2152 healthcare professionals (82% response rate). A majority of healthcare professionals reported a positive attitude to resuscitation. Paper V was a register study of patients suffering from cardiac arrest. The intervention tended not to reduce the delay to start of treatment or to increase overall survival. However, our results suggested indirect signs of an improved cerebral function among survivors. In conclusion, CPR education and the introduction of AEDs in-hospital – improved healthcare professionals knowledge, skills, and attitudes – did not improve patients’ survival to hospital discharge, but the functional status among survivors improved

Smartphone activated community first responders' experiences of out-of-hospital cardiac arrests alerts, a qualitative study.

Aim: The aim was to illustrate how community first responders perceive out-of-hospital cardiac arrest alerts delivered via smartphone, what support they have and how they cope with potentially distressing experiences. Method: A qualitative interview study was conducted with a volunteer sample of 14 community first responders in two regions of Sweden. The interviews were transcribed and analysed using thematic analysis with a data-driven inductive approach supported by NVivo 1.3. Results: The responders' experiences were illustrated in three main themes, each including several subthemes: 1) Profound wish to help, including the sense of importance and sense of emergency; 2) Facing the situation, including essential actions performed in collaboration, confidence from training and experience, challenges posed by unforeseen situations and ethical dilemmas, and coping with emotional reactions; and 3) Potential for improvements, including technical and communication development, feedback and debriefing, training and social marketing. Conclusion: The community first responders were motivated and eager to help but simultaneously feared the mission and were not always prepared for their own reactions in the emergency when dispatched. Although cardiopulmonary resuscitation training and experience gave them skills that enabled them to act constructively, they faced situations that might be facilitated by improvements in the community first responder system and further training. The responders were proud of their efforts and were good ambassadors for the system. Appreciation of their commitment, better preparation and providing support in the aftermath of an emergency appears to be a good investment in societies' efforts to bring quick help to distressed persons

Compliance with cardiopulmonary resuscitation guidelines in witnessed in-hospital cardiac arrest events and patient outcome on monitored versus non-monitored wards

BACKGROUND: Adherence to cardiopulmonary resuscitation (CPR) guidelines in treatment of in-hospital cardiac arrest (IHCA) have been associated with favourable patient outcome. The aim of this study was to evaluate if compliance with initial CPR guidelines and patient outcome of witnessed IHCA events were associated with the place of arrest defined as monitored versus non-monitored ward. METHODS: A total of 956 witnessed IHCA events in adult patients at six hospitals during 2018 to 2019, were extracted from the Swedish Registry of Cardiopulmonary Resuscitation. Initial CPR guidelines were: ≤ 1 min from collapse to alert of the rapid response team, ≤ 1 min from collapse to start of CPR, ≤ 3 min from collapse to defibrillation of shockable rhythm. RESULTS: The odds of compliance with guidelines was higher on monitored wards vs non-monitored wards, even after adjustment for factors that could affect staffing and resources. The place of arrest was not a significant factor for sustained return of spontaneous circulation, survival at 30 days, or neurological status at discharge, when adjusting for clinically relevant confounders. Compliance with initial CPR guidelines remained a significant factor for survival to 30 days and favourable neurological outcome at discharge regardless of other confounders. CONCLUSION: Compliance with initial CPR guidelines was higher in witnessed IHCA events on monitored wards than on non-monitored wards, which indicates that healthcare professionals in monitored wards are quicker to recognize a cardiac arrest and initiate treatment. When initial CPR guidelines are followed, the place of arrest does not influence patient outcome

Incidence and case ascertainment of treated in-hospital cardiac arrest events in a national quality registry – a comparison of reported and non-reported events

Background: Approximately 2,500 in-hospital cardiac arrest (IHCA) events are reported annually to the Swedish Registry of Cardiopulmonary Resuscitation (SRCR) with an estimated incidence of 1.7/1,000 hospital admissions. The aim of this study was to evaluate the compliance in reporting IHCA events to the SRCR and to compare reported IHCA events with possible non-reported events, and to estimate IHCA incidence. Methods: Fifteen diagnose codes, eight Classification of Care Measure codes, and two perioperative complication codes were used to find all treated IHCAs in 2018-2019 at six hospitals of varying sizes and resources. All identified IHCA events were cross-checked against the SRCR using personal identity numbers. All non-reported IHCA events were retrospectively reported and compared with the prospectively reported events. Results: A total of 3,638 hospital medical records were reviewed and 1,109 IHCA events in 999 patients were identified, with 254 of the events not found in the SRCR. The case completeness was 77% (range 55-94%). IHCA incidence was 2.9/1,000 hospital admissions and 12.4/1,000 admissions to intensive care units. The retrospectively reported events were more often found on monitored wards, involved patients who were younger, had less comorbidity, were often found in shockable rhythm and more often achieved sustained spontaneous circulation, compared with in prospectively reported events. Conclusion: IHCA case completeness in the SRCR was 77% and IHCA incidence was 2.9/1,000 hospital admissions. The retrospectively reported IHCA events were found in monitored areas where the rapid response team was not alerted, which might have affected regular reporting procedures

Cardiopulmonary Resuscitation and Vital Function Failure Refresher Training Strengthen Healthcare Professionals' Self-Assessed Abilities : A Questionnaire-Based Pilot Study

Refresher training in cardiopulmonary resuscitation and recognition of patients with failure in vital functions are often completed on separate occasions. In this study, 63 healthcare professionals participated in a pilot course and self-assessed their abilities before and after the course. Combining training scenarios with different diagnoses of patient cases provided a real-life learning environment. The training strengthened the perceived ability of healthcare professionals to respond to an acute situation of a patient with failure of vital functions