Discharge Planning Advisor: Quick classes in CPR ensure safer discharge

Classes help caregivers, kids with special needs

Cardiopulmonary resuscitation (CPR) is a good skill for every parent to learn, says Jennifer Bay, RN, BSN, the CPR coordinator for Children’s Healthcare of Atlanta. If adults who spend a lot of time with children know CPR, they are less likely to panic when an accident occurs and will know what to do until the emergency medical service team (EMS) arrives.

For some parents, however, learning CPR is imperative for the welfare of their child. That’s why CPR is offered on Monday, Wednesday, and Friday to parents with children admitted to either hospital within the Children’s Healthcare system. Most attend because the physician has ordered CPR for the main caregiver before the child is discharged. Others hear about the class when it is announced or a nurse tells them, and they simply walk in.

Those parents sent by physicians usually have children with heart defects, multiple health problems, or babies with apnea who will be on an apnea monitor at home. Should the child stop breathing, these parents need to know the steps for CPR.

It is not a class offered to the community. Children’s has community CPR classes throughout the year, says Bay. At the community classes, parents are certified following the instruction, and the certification process takes time.

The inpatient class only lasts an hour and is designed to teach parents in a short period of time what they need to do in an emergency. "The parents walk out of the class knowing the skills to keep their child alive until EMS arrives. An hour is long enough for parents to get the instruction they need, and they aren’t away from their child’s bedside for too long," she says.

The CPR instructors are contract employees, and they show up for the classes at the scheduled time whether a physician has ordered CPR instruction for a caregiver. If caregivers show up for the class, they teach; and if not, they go home, says Bay. "In this way, the classes are on a set basis and the physicians and staff know when they are held. If a caregiver needs to learn CPR on a day it is not offered, staff do the teaching," she says.

The inpatient CPR classes are open to any family member whether they are the main caregiver or not. Grandparents or a teen-age sibling who might baby-sit often will attend. Classes are limited to eight people so each participant has hands-on instruction.

Getting the information across

The class is taught by verbal instruction and demonstration on manikins with parents demonstrating the observed skill back to the instructor. "Seeing and doing is the best way to learn," says Bay.

Instructors teach everyone child CPR, which is for children ages 1 to 8. If someone in the class has a baby and needs to learn infant CPR, which is for children younger than 1, he or she receives individual instruction after the class.

The basic difference in CPR for various age groups is in the chest compressions, whether fingers are used or the heel of the hand, the placement of the fingers or hand, and the depth of the compressions.

With infants, the third and fourth fingers are positioned in the center of the baby’s chest half an inch below the nipples and pressed down ½ to 1 inch. One breath is followed by five of these gentle chest compressions.

With children, the heel of one hand is used for chest compressions with the person administering CPR pressing the sternum down 1 to 1½ inches. As with infants, one full breath is followed by five chest compressions.

Parents are encouraged to attend the community outreach CPR class for more in-depth instruction after their child is discharged from the hospital. Often they will return to the inpatient class more than once to learn the skill better if their child is in the hospital for any length of time. Parents receive pocket cards and teaching sheets that list the steps for CPR, and they are instructed to carry the card with them and post the sheets throughout their house.