Several clinical incidences led to a review of resuscitation care to patients in a tertiary level university hospital. The organization’s ability to respond effectively to a sudden deterioration of an inpatient was hampered by multi-system challenges. Effective resuscitation involves effective technique (Compressions and breaths) and the early use of defibrillation. Many victims of cardiac arrest do not receive immediately effective Basic Life Support (BLS), even when it is given by trained Health Care Professionals (HCPs), the technique may be inadequate or incorrect. Although resuscitation guidelines provide a logical, sequential algorithmic approach, they have mainly emphasized technical tasks performed by individual rescuers but not addressed issues of adapting to the complex nature of hospital resuscitations. Part of this complexity relates to the fact that in a healthcare environment resuscitations are usually performed by teams of responders, not by isolated rescuers.
An organizational wide review of resuscitation care was undertaken by multidisciplinary team of clinicians and organizational leaders. Nursing Executive Services established a quality improvement taskforce utilizing Failure to Rescue methodology. Variations in resuscitation care, equipment, personnel, skill and knowledge were identified. A process of standardization of resuscitation care was undertaken; including activation, communication, equipment, personnel involved in code blue response. This involved a systemic review of training, education, equipment, processes, products and supplies. The taskforce developed training and monitoring programs to build a standardized universal resuscitation care system across the hospital and a Code Blue Nurse Coordinator role was established. Development of First Responder role and advanced nursing role to use the Automated External Defibrilator (AED) through Multidisciplinary Code Blue Simulations was successfully done. Post Code Blue debriefing was implemented in all nursing units.
Nursing Services in collaboration with other health professionals established a rigorous resuscitation care system across the hospital. Achievements include 98% of all crash cart are ready for use within sixty (60) minutes. Bedside resuscitation care, early defibrillation, staff assertiveness, closed loop communication, staff morale, mutual respect dramatically improved. All resuscitation equipment is standardized through out the hospital. First Responder simulation and Physician Teamleader, Respiratory therapist & Code Blue Nurses multidisciplinary simulation program ongoing. Critical Care Nurses certified to use the AED if Physician Teamleader is not present.
Achieved standardization of all resuscitation equipment has given reassurance and proven across the board high quality and prompt resuscitation care. The process of team building, occurring in the early and most vulnerable phase of resuscitation, is of particular importance. This early time point is difficult to capture in real cardiac arrests and thus simulator-based studies have provided important insights. Results demonstrated a faster response to patients requiring resuscitation care, greater efficiency in the provision of advanced life support, and a more effective multidisciplinary resuscitation response team.