Part 12: Education, implementation, and teamsстатья из журнала
Аннотация: Application of resuscitation science to improve patient care and outcomes requires effective strategies for education and implementation. Systematic reviews suggest that there are significant opportunities to improve education, enhance individual and team performance, and avoid delays in implementation of guidelines into practice. It is within this context that the International Liaison Consensus on Resuscitation (ILCOR) Education, Implementation, and Teams (EIT) Task Force was established and addressed 32 worksheet topics. Reviewers selected topics from the 2005 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) Science With Treatment Recommendations12005 American Heart Association Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.Circulation. 2005; 112: IV1-IV203Crossref PubMed Scopus (0) Google Scholar and new topics identified by an expert group. One challenge for the EIT Task Force was extrapolating outcomes from simulation studies to actual patient outcomes. During the evidence evaluation, if the PICO (Population, Intervention, Comparator, Outcome) question outcomes were limited to training outcomes such as improved performance on a manikin or simulator, studies were classified to a level of evidence (LOE) according to study design (e.g., a randomised controlled trial [RCT] on a manikin would be LOE 1). Manikin or simulator studies were labeled as LOE 5 irrespective of the study design if the PICO question also included patient outcomes. The following is a summary of key 2010 recommendations or changes related to EIT:•Efforts to implement new resuscitation guidelines are likely to be more successful if a carefully planned, multifaceted implementation strategy is used. Education, while essential, is only one element of a comprehensive implementation strategy.•All courses should be evaluated to ensure that they reliably achieve the program objectives. Training should aim to ensure that learners acquire and retain the skills and knowledge that will enable them to act correctly in actual cardiac arrests.•Life support knowledge and skills, both basic and advanced, can deteriorate in as little as 3–6 months. Frequent assessments and, when needed, refresher training are recommended to maintain knowledge and skills.•Short video/computer self-instruction courses with minimal or no instructor coaching, combined with hands-on practice (practice-while-you-watch), can be considered as an effective alternative to instructor-led basic life support (cardiopulmonary resuscitation [CPR] and automated external defibrillator [AED]) courses.•Laypeople and healthcare providers (HCPs) should be trained to start CPR with chest compressions for adult victims of cardiac arrest. If they are trained to do so, they should perform ventilations. Performing chest compressions alone is reasonable for trained individuals if they are incapable of delivering airway and breathing maneuvers to cardiac arrest victims.•AED use should not be restricted to trained personnel. Allowing use of AEDs by individuals without prior formal training can be beneficial and may be lifesaving. Since even brief training improves performance (e.g., speed of use, correct pad placement), it is recommended that training in the use of AEDs be provided.•CPR prompt or feedback devices improve CPR skill acquisition and retention and may be considered during CPR training for laypeople and healthcare professionals. These devices may be considered for clinical use as part of an overall strategy to improve the quality of CPR.•It is reasonable to wear personal protective equipment (PPE) (e.g., gloves) when performing CPR. CPR should not be delayed or withheld if PPE is not available unless there is a clear risk to the rescuer.•Manual chest compressions should not continue during the delivery of a shock because safety has not been established. Several important knowledge gaps were identified during the evidence review process:•The optimal duration and type of initial training to acquire resuscitation knowledge and skills.•The optimal frequency and type of refresher training required to maintain resuscitation knowledge and skills.•The optimal use of assessment as a tool to promote the learning of resuscitation knowledge and skills.•The impact of experience in actual resuscitation attempts on skill decay and the need for refresher training.•The impact of specific training interventions on patient outcomes.•A standardised nomenclature and definitions for different types of simulation training and terms such as ‘high fidelity simulation,’ ‘feedback,’ ‘briefing’ and ‘debriefing.’•The most effective and efficient methods of disseminating information about new resuscitation interventions or guidelines to reduce time to implementation.•For cardiac resuscitation centres (facilities providing a comprehensive package of post resuscitation care), the optimal emergency medical services (EMS) system characteristics, safe patient transport interval (time taken to travel from scene to hospital), optimal mode of transport (e.g., ground ambulance, helicopter), and role of secondary transport (transfer from receiving hospital to a resuscitation centre). The EIT Task Force organised its work into five major sections:•Education—including who should be trained and how to prepare for training, the use of specific instructional strategies and techniques, retraining intervals, retention of knowledge and skills, and assessment methods.•Risks and effects on the rescuer of CPR training and actual CPR performance.•Rescuer willingness to respond.•Implementation and teams—including a framework for implementation efforts as well as individual and team factors associated with success.•Ethics and outcomes. Effective and efficient resuscitation education is one of the essential elements in the translation of guidelines into clinical practice. Educational interventions need to be population specific (e.g., lay rescuers, HCPs) and evaluated to ensure that they achieve the desired educational outcomes—not just at the end of the course but also during actual resuscitation events. Retention of knowledge and skills should be confirmed through assessment and not be assumed to persist for pre-established time intervals. Who should be trained and how should they prepare for training? Download .pdf (.06 MB) Help with pdf files EIT-012A Download .pdf (.06 MB) Help with pdf files EIT-012B For lay providers requiring basic life support training, does focusing training on high-risk populations, compared with no such targeting improve outcomes (e.g., bystander CPR, survival)? In three studies (LOE 12Dracup K. Moser D.K. Guzy P.M. Taylor S.E. Marsden C. Is cardiopulmonary resuscitation training deleterious for family members of cardiac patients?.Am J Public Health. 1994; 84: 116-118Crossref PubMed Google Scholar; LOE 23Kliegel A. Scheinecker W. Sterz F. Eisenburger P. Holzer M. Laggner A.N. The attitudes of cardiac arrest survivors and their family members towards CPR courses.Resuscitation. 2000; 47: 147-154Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar, 4Cheng Y. Hu S. Yen D. Kao W. Lee C. Targeted mass CPR training for families of cardiac patients—experience in Taipei City.Tzu Chi Med J. 1997; 9: 273-278Google Scholar), people reported that they would be more willing to perform bystander CPR on family members than on nonrelatives. One LOE 2 study5Swor R. Khan I. Domeier R. Honeycutt L. Chu K. Compton S. CPR training and CPR performance: do CPR-trained bystanders perform CPR?.Acad Emerg Med. 2006; 13: 596-601Crossref PubMed Google Scholar of people who called 911 found that unless family members had received CPR training, they were less likely to perform CPR than unrelated bystanders. Computer modeling (LOE 5)6Swor R. Fahoome G. Compton S. Potential impact of a targeted cardiopulmonary resuscitation program for older adults on survival from private-residence cardiac arrest.Acad Emerg Med. 2005; 12: 7-12Crossref PubMed Google Scholar suggested that very large numbers of older adults would need to be trained to achieve a sufficient increase in private residence bystander CPR rates to improve survival. Twelve studies (LOE 12Dracup K. Moser D.K. Guzy P.M. Taylor S.E. Marsden C. Is cardiopulmonary resuscitation training deleterious for family members of cardiac patients?.Am J Public Health. 1994; 84: 116-118Crossref PubMed Google Scholar, 7Dracup K. Guzy P.M. Taylor S.E. Barry J. Cardiopulmonary resuscitation (CPR) training: consequences for family members of high-risk cardiac patients.Arch Intern Med. 1986; 146: 1757-1761Crossref PubMed Google Scholar, 8Dracup K. Moser D.K. Doering L.V. Guzy P.M. Juarbe T. A controlled trial of cardiopulmonary resuscitation training for ethnically diverse parents of infants at high risk for cardiopulmonary arrest.Crit Care Med. 2000; 28: 3289-3295Crossref PubMed Google Scholar, 9Ingram S. Maher V. Bennett K. Gormley J. The effect of cardiopulmonary resuscitation training on psychological variables of cardiac rehabilitation patients.Resuscitation. 2006; 71: 89-96Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar, 10Moser D.K. Dracup K. Doering L.V. Effect of cardiopulmonary resuscitation training for parents of high-risk neonates on perceived anxiety, control, and burden.Heart Lung. 1999; 28: 326-333Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar, 11Moser D.K. Dracup K. Impact of cardiopulmonary resuscitation training on perceived control in spouses of recovering cardiac patients.Res Nurs Health. 2000; 23: 270-278Crossref PubMed Google Scholar; LOE 23Kliegel A. Scheinecker W. Sterz F. Eisenburger P. Holzer M. Laggner A.N. The attitudes of cardiac arrest survivors and their family members towards CPR courses.Resuscitation. 2000; 47: 147-154Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar, 12Sigsbee M. Geden E.A. Effects of anxiety on family members of patients with cardiac disease learning cardiopulmonary resuscitation.Heart Lung. 1990; 19: 662-665PubMed Google Scholar; LOE 413McDaniel C.M. Berry V.A. Haines D.E. DiMarco J.P. Automatic external defibrillation of patients after myocardial infarction by family members: practical aspects and psychological impact of training.Pacing Clin Electrophysiol. 1988; 11: 2029-2034Crossref PubMed Google Scholar, 14Messmer P. Meehan R. Gilliam N. White S. Donaldson P. Teaching infant CPR to mothers of cocaine-positive infants.J Contin Educ Nurs. 1993; 24: 217-220PubMed Google Scholar; LOE 515Groeneveld P.W. Owens D.K. Cost-effectiveness of training unselected laypersons in cardiopulmonary resuscitation and defibrillation.Am J Med. 2005; 118: 58-67Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar, 16Swor R. Compton S. Estimating cost-effectiveness of mass cardiopulmonary resuscitation training strategies to improve survival from cardiac arrest in private locations.Prehosp Emerg Care. 2004; 8: 420-423PubMed Google Scholar) reported that training of patients and family members in CPR provided psychological benefit. Two LOE 1 studies7Dracup K. Guzy P.M. Taylor S.E. Barry J. Cardiopulmonary resuscitation (CPR) training: consequences for family members of high-risk cardiac patients.Arch Intern Med. 1986; 146: 1757-1761Crossref PubMed Google Scholar, 17Dracup K. Moser D.K. Taylor S.E. Guzy P.M. The psychological consequences of cardiopulmonary resuscitation training for family members of patients at risk for sudden death.Am J Public Health. 1997; 87: 1434-1439Crossref PubMed Google Scholar reported that negative psychological effects on patients can be avoided by providing social support. There is insufficient evidence to support or refute the use of training interventions that focus on high-risk populations. Training with social support reduces family member and patient anxiety, improves emotional adjustment, and increases feelings of empowerment. Download .pdf (.11 MB) Help with pdf files EIT-018A For advanced life support providers undergoing advanced life support courses, does the inclusion of specific precourse preparation (e.g., e-learning and pretesting), as opposed to no such preparation, improve outcomes (e.g., same skill assessment but with less face-to-face [instructor] hands-on training)? Eight studies (LOE 118Schwid H.A. Rooke G.A. Ross B.K. Sivarajan M. 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Any method of precourse preparation that is aimed at improving knowledge and skills or reducing instructor-to-learner face-to-face time should be formally assessed to ensure equivalent or improved learning outcomes compared with standard instructor-led courses. There are multiple methods to deliver course content. This section examines specific instructional methods and strategies that may have an impact on course outcomes. Download .pdf (.05 MB) Help with pdf files EIT-002A Download .pdf (.06 MB) Help with pdf files EIT-002B For lay rescuers and HCPs, does the use of specific instructional methods (video/computer self-instruction), compared with traditional instructor-led courses, improve skill acquisition and retention? Twelve studies (LOE 142Lynch B. Einspruch E.L. Nichol G. Becker L.B. Aufderheide T.P. Idris A. 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A non-randomized comparison of e-learning and classroom delivery of basic life support with automated external defibrillator use: a pilot study.Int J Nurs Pract. 2008; 14: 427-434Crossref PubMed Scopus (15) Google Scholar, 52Liberman M. Golberg N. Mulder D. Sampalis J. Teaching cardiopulmonary resuscitation to CEGEP students in Quebec—a pilot project.Resuscitation. 2000; 47: 249-257Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar, 53Jones I. Handley A.J. Whitfield R. Newcombe R. Chamberlain D. A preliminary feasibility study of a short DVD-based distance-learning package for basic life support.Resuscitation. 2007; 75: 350-356Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar) demonstrated that basic life support skills can be acquired and retained at least as well and, in some cases, better using video-based self-instruction (practice-while-you-watch) compared with traditional instructor-led courses. Video-based self-instruction lasted from 8 to 34 min, whereas instructor-led courses were usually 4–6 h in duration. One LOE 1 study54Brannon T.S. White L.A. Kilcrease J.N. Richard L.D. Spillers J.G. Phelps C.L. Use of instructional video to prepare parents for learning infant cardiopulmonary resuscitation.Proc (Bayl Univ Med Cent). 2009; 22: 133-137PubMed Google Scholar demonstrated that prior viewing of a video on infant CPR before an instructor-led course improved skill acquisition. When compared with traditional instructor-led CPR courses, various self-instructional and shortened programs have been demonstrated to be efficient (from the perspective of time) and effective (from the perspective of skill acquisition) in teaching CPR skills to various populations. Short video/computer self-instruction (with minimal or no instructor coaching) that includes synchronous hands-on practice (practice-while-you-watch) in basic life support can be considered as an effective alternative to instructor-led courses. Download .pdf (.15 MB) Help with pdf files EIT-013A Download .pdf (.1 MB) Help with pdf files EIT-013B For basic life support providers (lay or HCP) requiring AED training, are there any specific training interventions, compared with traditional lecture/practice sessions, that increase outcomes (e.g., skill acquisition and retention, actual AED use)? One LOE 2 study55Castren M. Nurmi J. Laakso J.P. Kinnunen A. Backman R. Niemi-Murola L. Teaching public access defibrillation to lay volunteers—a professional health care provider is not a more effective instructor than a trained lay person.Resuscitation. 2004; 63: 305-310Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar demonstrated that training delivered by laypeople is as effective as training by HCPs. One LOE 1 study56Xanthos T. Ekmektzoglou K.A. Bassiakou E. et al.Nurses are more efficient than doctors in teaching basic life support and automated external defibrillator in nurses.Nurse Educ Today. 2009; 29: 224-231Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar reported that instruction by nurses, as compared with physicians, resulted in better skill acquisition. Four studies (LOE 246Reder S. Cummings P. Quan L. 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Год издания: 2010
Авторы: Jasmeet Soar, Mary E. Mancini, Farhan Bhanji, John E. Billi, Jennifer Dennett, Judith Finn, Matthew Huei‐Ming, Gavin D. Perkins, David L. Rodgers, Mary Fran Hazinski, Ian Jacobs, Peter T. Morley
Издательство: Elsevier BV
Источник: Resuscitation
Ключевые слова: Cardiac Arrest and Resuscitation, Simulation-Based Education in Healthcare, Disaster Response and Management
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