Nurse-initiated Defibrillation: Are Nurses Confident Enough?
Nurse-initiated Defibrillation: Are Nurses Confident Enough?
Objectives To determine the capability of nurses to identify ventricular fibrillation (VF) and ventricular tachycardia (VT) rhythms on an ECG and carry out subsequent defibrillation on their own as soon as they identify and confirm cardiac arrest.
Methods This was a prospective cohort study to determine the capability of emergency department (ED) nurses to recognise VF or pulseless VT correctly and their willingness to perform defibrillation immediately in an ED of a teaching hospital in Hong Kong. A questionnaire was completed before and after a teaching session focusing on the identification of rhythms in cardiac arrest and defibrillation skills. Correct answers for both ECG interpretation and defibrillation decisions scored one point for each question. The differences in mean scores between the pre-teaching and post-teaching questionnaires of all nurses were calculated.
Results 51 pre-teaching and 43 post-teaching questionnaires were collected. There were no statistically significant changes in ECG scores after teaching. For defibrillation scores, there was an overall improvement in the defibrillation decision (absolute mean difference 0.42, p=0.014). Performance was also improved by the teaching (absolute mean difference 0.465, p=0.046), reflected by the combination of both scores. Two-thirds (67%) of nurses became more confident in managing patients with shockable rhythms.
Conclusion Nurses improve in defibrillation decision-making skills and confidence after appropriate brief, focused in-house training.
The survival rate of in-hospital cardiac arrest remains low despite the extensive efforts of different resuscitation councils to improve clinical management of this common condition. The survival-to-discharge rate ranges from 15.3% to 37%. Nurses are usually the first healthcare staff to identify patients with cardiac arrest. Initial rhythm recognition is crucial to the management of patients with cardiac arrest because time is critical for survival in patients whose cardiac arrest rhythm is ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT).
Early defibrillation is a major key to increase survival, and therefore the use of an automated external device is included in modern standard basic life support (BLS) training. This leads to better survival rates for cardiac arrests outside critical care areas. Boyde and Wotton found that the majority of nurses can effectively manage all components of cardiopulmonary resuscitation (CPR). Ideally, all nurses should also be competent to recognise VF or pulseless VT and perform defibrillation within the first few seconds after collapse, and before any doctor arrives. On the other hand, it is equally important that a nurse should not misinterpret the ECG and give an unnecessary defibrillation shock to the patient.
It has been shown that the training of nurses in advanced cardiac life support (ACLS) is strongly related to improved survival for patients with cardiac arrest. Nurses can recognise shockable rhythms early and carry out defibrillation immediately. In addition, up-to-date training and greater self-confidence can lead to improved performance for medical professionals in resuscitation and subsequently increased survival. Nurses' confidence and perceived technical and non-technical skills during patient clinical emergencies have been shown to be enhanced following simulation. Such training should be based on inhospital scenarios and current evidence-based guidelines, including the recognition of sick patients, and should be taught using simulations of a variety of cardiac arrest scenarios. This will ensure that the training reflects the potential situations that nurses may face in practice.
However, there is lack of sufficient data about changes in performance after the implementation of nurse-initiated defibrillation. Some studies support the concept but they have failed to compare the outcomes objectively after implementing this technique.
The aim of the current study was to determine the capability of nurses to identify VF and VT rhythms on an ECG and carry out subsequent defibrillation on their own as soon as they identify and confirm cardiac arrest.
The results may affect the emphasis of nurses' undergraduate and postgraduate training including ECG interpretation and defibrillation skills, which in turn may impact our current patient management practice.
Abstract and Introduction
Abstract
Objectives To determine the capability of nurses to identify ventricular fibrillation (VF) and ventricular tachycardia (VT) rhythms on an ECG and carry out subsequent defibrillation on their own as soon as they identify and confirm cardiac arrest.
Methods This was a prospective cohort study to determine the capability of emergency department (ED) nurses to recognise VF or pulseless VT correctly and their willingness to perform defibrillation immediately in an ED of a teaching hospital in Hong Kong. A questionnaire was completed before and after a teaching session focusing on the identification of rhythms in cardiac arrest and defibrillation skills. Correct answers for both ECG interpretation and defibrillation decisions scored one point for each question. The differences in mean scores between the pre-teaching and post-teaching questionnaires of all nurses were calculated.
Results 51 pre-teaching and 43 post-teaching questionnaires were collected. There were no statistically significant changes in ECG scores after teaching. For defibrillation scores, there was an overall improvement in the defibrillation decision (absolute mean difference 0.42, p=0.014). Performance was also improved by the teaching (absolute mean difference 0.465, p=0.046), reflected by the combination of both scores. Two-thirds (67%) of nurses became more confident in managing patients with shockable rhythms.
Conclusion Nurses improve in defibrillation decision-making skills and confidence after appropriate brief, focused in-house training.
Introduction
The survival rate of in-hospital cardiac arrest remains low despite the extensive efforts of different resuscitation councils to improve clinical management of this common condition. The survival-to-discharge rate ranges from 15.3% to 37%. Nurses are usually the first healthcare staff to identify patients with cardiac arrest. Initial rhythm recognition is crucial to the management of patients with cardiac arrest because time is critical for survival in patients whose cardiac arrest rhythm is ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT).
Early defibrillation is a major key to increase survival, and therefore the use of an automated external device is included in modern standard basic life support (BLS) training. This leads to better survival rates for cardiac arrests outside critical care areas. Boyde and Wotton found that the majority of nurses can effectively manage all components of cardiopulmonary resuscitation (CPR). Ideally, all nurses should also be competent to recognise VF or pulseless VT and perform defibrillation within the first few seconds after collapse, and before any doctor arrives. On the other hand, it is equally important that a nurse should not misinterpret the ECG and give an unnecessary defibrillation shock to the patient.
It has been shown that the training of nurses in advanced cardiac life support (ACLS) is strongly related to improved survival for patients with cardiac arrest. Nurses can recognise shockable rhythms early and carry out defibrillation immediately. In addition, up-to-date training and greater self-confidence can lead to improved performance for medical professionals in resuscitation and subsequently increased survival. Nurses' confidence and perceived technical and non-technical skills during patient clinical emergencies have been shown to be enhanced following simulation. Such training should be based on inhospital scenarios and current evidence-based guidelines, including the recognition of sick patients, and should be taught using simulations of a variety of cardiac arrest scenarios. This will ensure that the training reflects the potential situations that nurses may face in practice.
However, there is lack of sufficient data about changes in performance after the implementation of nurse-initiated defibrillation. Some studies support the concept but they have failed to compare the outcomes objectively after implementing this technique.
The aim of the current study was to determine the capability of nurses to identify VF and VT rhythms on an ECG and carry out subsequent defibrillation on their own as soon as they identify and confirm cardiac arrest.
The results may affect the emphasis of nurses' undergraduate and postgraduate training including ECG interpretation and defibrillation skills, which in turn may impact our current patient management practice.
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