Implementation of Resuscitation Quality Improvement to Improve CPR Confidence

The purpose of this evidence-based practice project was to promote cardiopulmonary resuscitation (CPR) confidence and self-efficacy for nursing staff by piloting a resuscitation quality improvement (RQI) program for basic life support (BLS) on a complex medical-surgical unit. Traditionally health care workers undergo biennial training leading to suboptimal CPR skill retention. Research indicates that skill decay occurs within three to six months, therefore additional frequent instruction is required to maintain competency for high-quality CPR skill performance. A medical-surgical unit identified CPR inconsistencies during quarterly mock code blue training as well as in an increase in rapid response team activations. When resuscitation knowledge and skills are assessed frequently, performance increases, leading to improved patient outcomes. The delivery of efficient and high-quality cardiopulmonary resuscitation (CPR) is critical components for survival during a cardiac arrest. Our team facilitated meetings with nursing leadership to obtain support for the implementation of RQI on a pilot unit. The team members included unit champions, educators, and nurse management. A pre-assessment of learning and quarterly surveys was collected to analyze the impact of RQI on staff confidence and self-efficacy over a six-month time frame. The plan-do- study act (PDSA) guided the project by breaking down each step to evaluate the outcomes, make improvements, and retest. All nursing staff were assigned the RQI training modules through an electronic learning platform for quarterly BLS which included didactic and hands on simulation.

Staff metrics were recorded through a voice assisted manikin to evaluate performance for ventilations and chest compressions with real-time feedback. The survey results indicated CPR skills improved from 23% to 47% from quarter one to quarter two. The findings initiated the transition of RQI BLS for the hospital. Currently, 62% of hospital staff are now enrolled in the RQI-BLS program. RQI is evidenced-based and recognized as the gold standard for CPR training. Competence is verified through quarterly course completion that meets national requirements. The project identified that CPR is a preventable harm and the vital need to improve cardiac arrest survival through CPR skill mastery and retention.

Evidence-based references
1. Oermann, M., Krusmark, M., Kardong-Edgren, S., Jastrzembski, T., & Gluck, K. (2021). Personalized training schedules for retention and sustainment of cardiopulmonary resuscitation skills. Simulation in Healthcare, 00(00). https://doi.10.1097/SIH.0000000000000559