Participant Testimonials

The following testimonials are from NRCPR participants sharing how they've benefitted from participating in NRCPR.

• The biggest changes we have made include:
  
  1. We have a formal definition to use for Code Blue.
  2. We have a national benchmark.
  3. NRCPR assisted us in the decision to purchase the AEDs. We could not defibrillate in dialysis in the 3 minute requirement.
  4. NRCPR gave us direction on writing up the CPR "report care" given to staff.
  5. We have changed our education about CPR events.
  6. We have changed the way we report CPR events to hospital committees and staff.
• We are forming a committee specific to Code Blues. We will be implementing improvement processes by way of the committee. Our first agenda item is documentation and changing the process of how we collect the code blue sheets. We got a lot of info through the conference that we will be using to implement the necessary changes within our facility.
• We had several codes on med-surg units that did not have suction available in the room. Now we have battery powered portable suction machines on each of the crash carts. We have also standardized crash carts throughout the entire hospital, clinics, and urgent cares.
• In Hospital Mortality Following Recurrent Cardiac Arrest: Two physicians have quantified the inpatient survival of patients experiencing two or more cardiac arrests in order to allow physicians and families to make data guided decisions regarding appropriate care following a first cardiac arrest. A retrospective observational analysis was performed of patients who experienced two or more cardiac arrests while at [our facility using] NRCPR data.
• Increase in Resuscitations on One Surgical Unit: It was noted that a surgical unit had an increase in the number of resuscitations in 2002. We had displayed the NRCPR results in a graph, so that this unit was seen to have the same number of resuscitations as the Intermediate Cardiac Care Unit and the Cardiac Surgical ICU. The CPR Committee is meeting with the nursing leadership on that unit & Director of Nursing Research to discuss the implications of this change. Using Access to extract data on these resuscitations, it was noted that:
  
  1. More arrests happen outside of day shift hours, with a significant number happening at night. We will explore staffing related to this finding.
  2. There is a higher number of unwitnessed arrests than reported throughout the rest of the hospital. We will explore staffing, and use of telemetry and pulse ox technology related to this finding.
  3. The AED (the defibrillator present on their unit) was applied in only 3 cases. We will explore why the number is so low. Only 2 of their resuscitations were pure respiratory in nature.
  4. Those patients who survived were PEA and respiratory. Neither of their patients in VF were discharged, though one was immediately resuscitated.
  5. Many of their respiratory events are not being reported on our CPR Record, so we are not tracking all emergency events on this unit.
• We have standardized of all code carts in the facility and are moving toward standardizing the outpatient satellites. We have also standardized the vendor for defib/AED purchases. We added chaplains to group page for code blues.
• We have revised our code blue flow sheet to improve our documentation process. Documentation was also an issue, so we added a documentation review process to the responsibilities of the Critical Care Charge who responds of all codes. Intubation times are frequently greater than benchmark. We developed run chart to place in Pulmonary Services conference room so staff can have a "picture" of how they are meeting that standard. This provides visual quarterly feedback.
• We changed documentation and restarted the CPR committee. I have also changed the job descriptions for all ICU and CCU nurses. They are now required to have ACLS - including me.
• [Our hospital] has only been able to use NRCPR once. Even with this we have instituted these changes since we joined the program:
  
  1. We use the data collection forms for every code in our facility for QA even though they do not meet the criteria for data entry. We now have a universal system in place.
  2. The critique form is used as a hit and miss item but has also identified the need for nursing documentation and ACLS issues to be identified and corrected through course and classes.
  3. The above mentioned forms have helped identify lost revenue for the hospital due to the ability for an improved tracking system.
  4. The CODE Task Force is ready and willing to make any further improvements that the results from this quarter may show.
• Improvements that we have implemented include:
  
  • Change in code blue documentation form. This has improved completeness of documentation.
  • Identifying a primary position, House Supervisor, to complete the documentation to improve consistency.
  • Increased awareness of the value of ACLS among physicians. This led to increased physician participation in courses.
  • Provided more detailed information for presentations to Code Blue Committee and Performance Improvement Steering Committee.
• We added a clock to our crash cart so our times would be consistent and accurate. Also the critical care director likes to go to the codes and be the recorder so during the day she attends the codes and records which helps ensure consistent documentation. We have a code blue committee so the NRCPR data is presented at this committee as well as our process improvement meeting that meets quarterly.
• I would like to share two efforts that are 'in the works' within our organization.
  
  1. Our Cardiopulmonary Arrest Record is in revision. Our intent is to incorporate data regarding AED use and refine documentation of other interventions, i.e., ETT placement verification. We are using the template from NRCPR as a guide. We are also adding data options to capture patient status 12 hours prior to event in efforts to review care needs/management up to arrest.
  2. We are also adding an additional ACLS RN to the response team. This member's sole responsibility will be documentation.
• Actually we are preparing to change our documentation to capture more of the data that NRCPR ask for. For example, we currently don't document on our code sheet how the ETT is checked....although it is assumed that all do auscultation. But it isn't documented. Therefore, we are changing to incorporate the documentation so that assumptions aren't made. We have also identified issues with our code blue process and are working on that as well. Great things are happening!
• One thing that I have started on as a result of the meeting is a more efficient process of identifying quality issues during an event. I am working in conjunction with our pharmacist (they perform the event documentation) and have used the NRCPR template to create a quality review form. Those events identified will be forwarded for review at our Emergency Response Committee.
• We are in the process of adding a nurse to the code team, specifically to document the event. This RN documenting is to be either the charge nurse or house supervisor to provide maximum consistency. We found that our documentation leaves a lot to be desired.
• We have changed our documentation tool to better reflect what NRCPR is asking for. we also noted that we frequently give atropine first before epi for VF/VT. This has led to staff in-services with hope of improved outcomes. The ICU did not believe they were doing this until we went back and pulled some records that revealed your data was in fact correct.
• We have looked into the type of rhythms when compressions started- to look into better identifiers/education when to initiate the code call. We started getting code call list form facility operators to find out when code was called to time code team started compressions. We also improved documentation by adding a area for location of event, and an area to check off Intubation location was verified. [The NRCPR staff] was very helpful in assisting the above analysis.
• We have altered our code blue team to include 2 ACLS nurses for support and appropriate documentation. When we started the NRCPR we changed our documentation so that all of the information necessary was available. There may have been other changes but these are the ones that come to mind at this time.
• I have seen improvement in documentation but we are still working on that! We changed our whole documentation process when we joined NRCPR. I have seen improvement is getting epinephrine to patients within 5 minutes, but are still encouraging improvement on that too. We have become aware of our delays in getting patients intubated within 5 minutes and are looking for ways to improve that. We have become aware of time differences in clocks and other time pieces and are also searching ways to fix that problem.