Chris Laux MSN, RN, ACNS-BC, CCRN, PCCN

3 common problems that can occur with a hospital wide training program

3 reasons why a super user training program can improve a resuscitation training program

2 potential problems and the solutions to a super user training program

Statement from the 2013 AHA Consensus Statement on CPR quality: “Resuscitation training and education should

not be considered a course or a single ‘event’ but rather a long-term progression in the ongoing quest to optimize CPR quality”

AHA Consensus Report, Circulation, 2013

If BLS is performed infrequently by staff, skill acquisition decreases substantially within months

“Hands on” training programs that utilize a low-dose high frequency training method (every 3 months) increases: ◦ Initiating CPR within 1 min: 65% ◦ Defibrillate within 3 min: 67%

Delac et al, Crit Care Nurse Q, 2013 Sullivan et al, Resuscitation, 2015 Sutton et al, Pediatrics, 2011

AHA-RQI, Annotated Bibliography, 2015

a. ≥ 2x/month b. 1x/month c. Quarterly d. 1x/year e. Biannual (BLS/ACLS) f. Code blue training?

Only 25% of IHCA arrest are VF/pulseless VT

Staff are uncomfortable and unskilled using defibrillators

Chan, et.al., JAMA, 2010

Administration/management ◦ Safety concerns ◦ Financial concerns

Staff ◦ Mock codes take me away from patient care ◦ Training on my day off ◦ Training will show my flaws

Resources needed for a training program: Financial ◦ Simulation equipment costs ◦ Training costs to run simulations ◦ Employee costs to attend training

Staff Educator Simulation personnel

Educator resources ◦ Developing/facilitating training takes time Set up/take down of training sessions Scheduling educational sessions: rooms, trainer schedules,

staff schedules Providing educational materials/resources Researching evidence best practices ◦ Other job duties

MCICU RNs 40 staff Pharmacists 15 staff 3 East telemetry RNs (recorder) 21 staff 4E/5E telemetry RNs (defib RN) 38 staff First responder training too many to count!

total: 114++++++ Note: Individual role training and then group annual training Note: 2 house wide mock codes/month

Super user: Extensive knowledge Common with the implementation of a

electronic medical record (EMR) system Super user role: ◦ Train end users: Initial and ongoing ◦ Identify systems problems Equipment Workflow Personnel ◦ Collaborate with the code blue educator

Yuan CT, et al. BMC Med Inform Decis Mak, 2015

Competent in the code blue skill/ACLS certified

Good communicator Enthusiastic/Passionate about

resuscitation Patient/calm teacher Respected by staff Problem solver

McNieve JE, CIN, 2009 Yuan CT, et al. BMC Med Inform Decis Mak, 2015

https://www.youtube.com/watch?v=hRcvfuA0wDw

Erin: Defibrillator RN Super User

More readily available to the staff RN Increase in frequency of training Decrease in staff training costs Super user is “one of their own” Super user takes ownership of training,

increases unit moral and performance. Develop future educators

Simmons N, CIN, 2013 McNieve JE, CIN, 2009 Sullivan NJ, Resuscitation, 2015 Yuan CT, et al. BMC Med Inform Decis Mak, 2015

1. Code blue teams are multidisciplinary and team dynamics need to be practiced

2. Inconsistencies in training with multiple trainers

3. Training during work hours may cause the learner not to pay “full attention”

4. Increase incidence of super user burn out Stewart et al, Pediatric Emergency Care, 2017

1. Not the only method of training…used in conjunction with team training (i.e. mock codes)

2. Consistent training a. Develop an educational tool (check list, handouts, power

point presentation) b. Super user practice

3. Increase attentiveness:

a. Training in a quiet area, less busy time on the unit b. Coverage for the learner’s patient assignment

4. Consistently touch base with the super user

Glynn DM et al, JPN, 2017

A code blue training program requires many resources

One solution to the educator resource problem, utilize super users

A super user training program has many benefits and can improve code blue outcomes