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Are your staff up to date on the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care from the American Heart Association (AHA)? You’ll need to update them immediately, urges Marianne Gausche-Hill, MD, FACEP, FAAP, director of emergency medical services at Harbor-University of California at Los Angeles Medical Center in Torrance.
You may increase your liability risks if your practice is not consistent with the guidelines, warns Michele Wolff, RN, MSN, CCRN, professor of nursing at Saddleback College in Mission Viejo, CA. "I would challenge any medical professional who does not follow the guidelines," she says. "How would a nurse or physician answer the question, What evidence do you have that led you to implement an intervention that is contrary to the AHA guidelines and standard practice?’"
You have a professional responsibility to ensure your staff are practicing according to current policy, protocols, and community standards, Wolff says. "Based on this, a clinician who does not follow the latest AHA guidelines would have a difficult time using the I didn’t know’ defense," she says.
Encourage staff to take responsibility for teaching the new skills to each other, advises Teresa Ostler, RN, ED educator and pediatric advanced life support (PALS) coordinator at Primary Children’s Medical Center in Salt Lake City. "The shared learning approach takes some of the responsibility off of the manager and places it with the individual learner, where it really belongs," she says.
Here are effective ways to update staff on the new guidelines:
• E-mail. Use e-mail to alert staff where to download information about the guidelines or how to obtain copies, advises Gausche-Hill. (For this information, see "Resources" at end of this article.) Gausche-Hill also recommends attaching a lecture handout on the important changes to the guidelines for staff to review. "I am doing this now for our staff for the PALS changes," she reports.
• Courses. All regional AHA offices are providing updates on the new guidelines, with many national rollouts, says Mary Fran Hazinski, RN, MSN, senior science editor for the AHA’s emergency cardiovascular care committee and clinical specialist in the division of trauma in the departments of surgery and pediatrics at Vanderbilt University Medical Center in Nashville, TN. Contact your local AHA regional representative for information about rollout courses, Hazinski recommends.
• Guest lecturer. "This can be extremely helpful," Hazinski advises. "However, be sure that the person that provides the inservice is very familiar with the topic and can answer questions." She suggests contacting your AHA regional representative and inviting her to speak at a grand rounds or nursing inservice.
Gausche-Hill acknowledges that it can be difficult to get staff to participate in these meetings. "Offering continuing education credit is a must," she advises. "You also need to supply refreshments and make the program available at times when it is easy for staff to attend." For example, mornings are often less hectic in the ED, she notes. She suggests having several sessions, so that every staff member is able to attend one of the updates. (See "Get guest speakers at no cost to you," in this issue.)
• Mock codes. Use "mock codes" to present a patient scenario and have staff manage that patient at the bedside, says Gausche-Hill. Mock codes should be given when the ED is not hectic, with a physician or nurse acting as moderator, says Gausche-Hill. "A case is presented, and the team has to work through the case," she explains. "A rhythm simulator can be used to simulate the rhythm changes, and the moderator can give feedback during or after the code." For example, the respiratory therapist might begin doing bag-mask ventilation on the patient, a nurse could attempt an IV and place the patient on the monitor, and the physician could intubate and run the code, Gausche-Hill suggests.
• Educational materials. "There is a wealth of resources and references available to AHA instructors," says Hazinski. She recommends that all ED managers subscribe to Currents in Emergency Cardiovascular Care and obtain a copy of the guidelines from one of the AHA distributors for the department. (For ordering information, see "Resources.") ED nurses should schedule a "journal club" to discuss a different chapter of the guidelines each week or month, Hazinski suggests.
• Posted algorithms. Make sure the new algorithms are easily visible, says Ostler. "We post the PALS and ACLS [advanced cardiac life support] algorithms in a laminated color form on each crash cart for easy reference," she reports.
• Newsletters. Write articles for your ED’s newsletter reviewing the new medications, routes of administration, and side effects, recommends Ostler.
• Distribute learning packets. The ED at Primary Children’s is developing a "learning unit" or self-paced packet of information for the new PALS information, notes Ostler. The packets include a sheet that states the objectives and directions for completing the learning unit, current clinical articles, policies and handouts, a clinical skill checklist, and a post-test.
• Mini-inservices. At each staff meeting, educate staff about a single aspect of the new guidelines, suggests Ostler. "For example, teach everyone about vagal maneuvers and practice the straw technique,’" she says.
For more information about educating staff on the American Heart Association guidelines, contact:
• Marianne Gausche-Hill, MD, FACEP, FAAP, Harbor-UCLA Medical Center, 1000 W. Carson St., Box 21, Torrance, CA 90509. Telephone: (310) 222-3501. Fax: (310) 782-1763. E-mail: email@example.com.
• Mary Fran Hazinski, RN, MSN, Vanderbilt University Medical Center, 243 Medical Center S., 2100 Pierce Ave., Nashville, TN 37212. Telephone: (615) 936-0194. Fax: (615) 936-0185. E-mail: firstname.lastname@example.org.
• Teresa Ostler, RN, Emergency Department, Primary Children’s Medical Center, 100 N. Medical Drive, Salt Lake City, UT 84113-1100. Telephone: (801) 588-2823. Fax: (801) 588-2295. E-mail: PCTOSTLE@ihc.com.
• Michele Wolff, RN, MSN, CCRN, Saddleback College, 28000 Marguerite Parkway, Mission Viejo, CA 92692. Telephone: (949) 582-4222. Fax: (714) 536-6269. E-mail: email@example.com.
The Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care were published in the Aug. 22, 2000, issue of Circulation, the official journal of the American Heart Association (AHA). Reprints are available for $20 plus $7 shipping and handling. To order, contact: Channing L. Bete, 200 State Road, South Deerfield, MA 01373-0200. Telephone: (800) 611-6083 or (413) 665 7611. Fax: (800) 499-6464 or (413) 665 2671. E-mail: firstname.lastname@example.org. Web: www.channing-bete.com.
Key changes are outlined on the AHA web site (www.cpr-ecc.americanheart.org). Click on "What’s New" and "Guidelines Released."
The Fall 2000 issue of Currents in Emergency Cardiovascular Care contains a 28-page summary of the new guidelines. Individual copies are available for $5. To order a copy or to subscribe, contact: Currents OnLine.com, 27500 Interstate 45 N., Suite 124, Spring, TX 77386. Telephone: (888) 999-4210 or (281) 419-1992. Fax: (281) 419-8238 ext. 110. E-mail: email@example.com.