Case review
In this case review , the author reflects on the process of standardising CPR protocols and training in her practice .
A need for standardised CPR training was identified through feedback from new and existing team members , who reported feeling anxious about CPR , feeling ineffective during CPR and feeling insufficiently trained in CPR . These feelings were also present when observing CPR attempts . There was a lack of clarity around role assignment , and often documentation and timing were omitted .
The author and a colleague undertook additional CPR training themselves , in the form of the RECOVER ALS and BLS online courses , and subsequent in-person examinations . While the in-house training was being finalised , staff were also encouraged to undertake the RECOVER training .
The author created the training material , in collaboration with an anaesthesia colleague . CPR records were also created and implemented after a team meeting and feedback from other members of the veterinary nursing team . When reviewing the equipment , a need was identified for a CPR manikin . Once the budget was approved , this was purchased .
The author worked with the practice management to identify training slots and communicate with the team . All members of the team ( including receptionists , patient care assistants , clinicians and VNs ) were included in the training plan .
A staff list was created , time slots allocated and a record kept of when the training occurred . The training took place over a reasonable and manageable period . Various training slots were provided , considering the needs of the practice and the staff . The aim was to standardise the CPR training of all team members over a period of several months , which was realistic given the limitations of shift patterns and the availability of personnel to deliver the training .
The training sessions included small-group simulations with the manikin to cover BLS , and didactic sessions to cover the theory . Periodic large-group simulations were also performed to cover ALS .
Conclusions
The timing and facilitating of training activities are often the biggest barriers to standardising CPR in practice . As a profession , we need to establish clear protocols for CPR within our practices and allow time for training new and existing staff .
It is essential that managers and senior staff recognise the need for CPR training and help to facilitate it . This will include identifying and organising training opportunities for all team members .
We should be mindful not to assume prior CPR knowledge , experience or confidence in any team member . A whole-team approach is vital to achieving the best possible outcome for a patient requiring CPR .
REFERENCES
1 Fletcher DJ , Boller M , Brainard BM , Haskins SC , Hopper K , McMichael MA , et al . RECOVER evidence and knowledge gap analysis on veterinary CPR . Part 7 : Clinical guidelines . Journal of Veterinary Emergency and Critical Care . 2012 ; 22 ( S1 ): S102 – S131 . Available from : https :// doi . org / 10.1111 / j . 1476-4431.2012.00757 . x .
2 RECOVER Initiative . RECOVER Guidelines . Available from : https :// recoverinitiative . org / cpr-guidelines / current-recover-guideline [ Accessed 30 October 2023 ].
3 Resuscitation Council UK . Quality Standards : Acute Care . Available from : https :// www . resus . org . uk / library / quality-standards-cpr / quality-standards-acute-care [ Accessed 30 October 2023 ].
4 Daglius Dias R , Scalabrini Neto A . Stress levels during emergency care : a comparison between reality and simulated scenarios . Journal of Critical Care . 2016 ; 33 : 8 – 13 . Available from : https :// doi . org / 10.1016 / j . jcrc . 2016.02.010 .
5 Yeung JHY , Ong GJ , Davies RP , Gao F , Perkins GD . Factors affecting team leadership skills and their relationship with quality of cardiopulmonary resuscitation . Critical Care Medicine . 2012 ; 40 ( 9 ): 2617 – 2621 . Available from : https :// doi . org / 10.1097 / CCM . 0b013e3182591fda .
6 Hunziker S , Johansson AC , Tschan F , Semmer NK , Rock L , Howell MD , et al . Teamwork and leadership in cardiopulmonary resuscitation . Journal of the American College of Cardiology . 2011 ; 57 ( 24 ): 2381 – 2388 . Available from : https :// doi . org / 10.1016 / j . jacc . 2011.03.017 .
7 Clinical Human Factors Group . Our History . Available from : https :// chfg . org / chfg-history [ Accessed 2 November 2023 ].
Feedback was received and the training adjusted as required . It is now embedded into the induction of new staff , with an emphasis on both theoretical knowledge and simulations .
Simulations are now being developed to include some typical presentations of CPR , and looking at what an ECG and capnograph might represent in these cases . As with any quality improvement , this is an ongoing and continuous process .
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