Letter to the Editor

Abstract

We read with interest the paper by Murphy et al. [[1]Murphy M. Fitzsimons D. Does attendance at an immediate life support course influence nurses’ skill deployment during cardiac arrest?.Resuscitation. 2004; 62: 49-54Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar] in the July edition of Resuscitation. The study claims skill utilisation is poor amongst nurses after attending a Resuscitation Council (UK) Immediate Life Support (ILS) Course. We believe several important methodological limitations make it difficult to draw any firm conclusions from this study. At the time of the study, only 159 (23%) of the nurses who had current ILS training were still employed by the hospital and presumably were eligible to perform defibrillation or LMA insertion. Based on the size of the hospital, this figure probably represents about 10% of the total qualified nursing workforce. We are not told what proportion of the arrests were attended by ILS trained nurses. It is highly likely that most of the arrests that occurred in the study hospital, were attended by nurses, who did not hold a current ILS qualification. This will have been further confounded by the apparent infrequency with which the ward nurses encountered cardiac arrest patients in shockable rhythms. Unfortunately, the authors do not provide any information on the number of cardiac arrests that occurred in the ward environment with shockable rhythms. Extrapolating from the data previously reported by Spearpoint et al. [[2]Spearpoint K.G. McLean C.P. Zideman D.A. Early defibrillation and the chain of survival in ‘in-hospital’ adult cardiac arrest; minutes count.Resuscitation. 2000; 44: 165-169Abstract Full Text Full Text PDF PubMed Scopus (107) Google Scholar] (which showed only approximately 35% of cardiac arrests occurring on wards had shockable rhythms) it is possible that there may have been as few as 12 cardiac arrests during the study period that would have fulfilled the criteria for ward nurse defibrillation. We also hypothesize that the failure to develop a systematic approach to deliver post course support to participants will have had a much greater impact on skill utilisation than the course failing to train participants in those skills. The ILS course is designed to lay the foundations in terms of knowledge, attitudes and skills to facilitate course participants to function as first responders to patients in cardiac arrest. The course incorporates current educational principles and provides a standardised approach to delivering training in these skills [[3]Soar J, Perkins GD, Harris S, Nolan JP. The Resuscitation Council (UK). Immediate life support course. Resuscitation; 2002.Google Scholar]. The importance of on-going training and support is highlighted in the Council's Guidelines for Clinical Practise and Training [[4]Resuscitation Council (UK). Cardiopulmonary resuscitation—guidance for clinical practice and training in hospitals; 1999.Google Scholar] and recent ILCOR review of education in resuscitation [[5]Chamberlain D.A. Hazinski M.F. Education in resuscitation.Resuscitation. 2003; 59: 11-43Abstract Full Text Full Text PDF PubMed Scopus (152) Google Scholar]. This hypothesis is supported by the author's observations in the qualitative component of their study. They report increased confidence early after training, but a decline as time progresses and positive benefits from skill reinforcement in clinical practise. Further support to the importance of post course skill development is provided in the study by Baskett et al. [[6]Verghese C. Prior-Willeard P.F. Baskett P.J. Immediate management of the airway during cardiopulmonary resuscitation in a hospital without a resident anaesthesiologist.Eur J Emerg Med. 1994; 1: 123-125PubMed Google Scholar], which showed 55% utilisation of LMA insertion by nurses during resuscitation attempts within 12 months of initiating a training programme. Spearpoint (personal communication) has had similar successes with first responder nurse defibrillation on general wards through delivering on-going support and training after the ILS course. We believe this study serves to demonstrate the importance of integrating skills training with a strategic programme that trains a sufficient number of staff to achieve a critical mass, promotes skill deployment by first responders in clinical practise and provides adequate post-course support to promote and maintain skills.