Advanced Cardiac Life Support Certification Research Articles

Advanced cardiac life support certification for student pharmacists improves simulated patient survival

Background and purposeBasic life support (BLS) and advanced cardiac life support (ACLS) skills performance, as well as simulated patient survival, were compared for student pharmacist teams with and without at least one member with American Heart Association (AHA) ACLS certification. Educational activity and settingDoctor of pharmacy students in their third professional year completed a high-fidelity mannequin simulation. Within the previous year, 30 of 184 students (16%) completed ACLS certification. Rapid response teams (n = 31) of five to six members were formed through random student assignment. Two AHA instructors recorded and assessed performance using a checklist adapted from the AHA's standardized forms for BLS and ACLS assessment. Teams with and without ACLS certified members were compared for skills performance and simulated patient survival (i.e. correct performance of all BLS and ACLS skills). FindingsTeams with ACLS certified members (n = 21) were superior to teams without certified members (n = 10) for correct performance of all observed BLS and ACLS skills, including pulse assessment and medication selection for cardiovascular support. For teams who had ACLS certified members, simulated patient survival was 86% higher. The study groups did not differ in their ability to calculate a correct vasopressor infusion rate if warranted. SummaryBLS and ACLS skills performance were improved by AHA ACLS certification. Additionally, simulated patient survival was improved for teams with students who had at least one ACLS certified member.

Illinois Dental Anesthesia and Sedation Survey for 2016.

A statewide decennial survey was sent to practicing dentists holding sedation or general anesthesia permits to identify office sedation/general anesthesia trends and practices over the last 10 years. This survey constitutes the third such survey, spanning a total of 20 years. Of the 234 respondents in the 2016 survey, 34% held an Illinois moderate sedation permit and 64% held a general anesthesia permit. Oral and maxillofacial surgeons represented the majority of respondents (143/234; 61%). The remainder of responses were from general dentists (39; 17%) pediatric dentists (32; 14%), periodontists (16; 7%), dentist anesthesiologists (3; 1.3%) and 1 periodontist/dentist anesthesiologist. Surveys over the 20 years revealed the following significant trends: an increase in practitioners current in advanced cardiac life support certification, an increase in the number of non-oral maxillofacial surgeons with a sedation permit, an increase in providers of moderate sedation, and an increase in offices equipped with end-tidal CO2 and electrocardiogram monitoring. However, a number of providers were identified as not compliant with certain state mandates. For example, many respondents failed to meet minimum office team staffing requirements during sedation, hold semiannual office emergency drills, and establish written emergency management protocols.

Abstract 155: Undergraduate Student Nurse ACLS Certification to Improve Practice Transition and Confidence

Abstract Summary: Simulation research is well-established for existing teaching methods in academic settings. The study introduced an in-class simulation method focused on the transformation of a stagnant classroom into an engaging, simulation arena to improve student’s recognition of a deteriorating patient. In addition to the in-class simulation, a leveled code blue curriculum and code blue multi-patient simulation provided a foundation for students to complete an Advanced Cardiac Life Support (ACLS) certification prior to graduation from a traditional Baccalaureate of Science (BSN) nursing program. Purpose: The presentation synthesizes data on the impact of the in-class simulation experience. The specific area of interest is the ability of the nursing student to recognize and assess the deteriorating patient. It is through the swift acknowledgement of such life-threatening situations, that the development of code blue critical thinking can begin. In conjunction with simulation, a leveled code blue curriculum with the inclusion of an ACLS certification will facilitate student confidence for transition into clinical practice. Methods: An exploratory, single group design with a convenience sample of 92 BSN senior nursing students enrolled in the 3-credit, seventh semester medical-surgical, didactic nursing course. Variables: Variables included age, gender, race, exposure to code blue events in the clinical and work settings, and previous years of health care experience. Procedures: The modified 12-item survey, Code Blue Self-Confidence, assessed participant code blue confidence pre/post intervention. A demographic survey was utilized to measure correlative data with code blue skill confidence. Findings: Correlative findings revealed a significant improvement in student confidence with recognizing and intervening with the deteriorating patient to ensure swift implementation of code blue processes. Recommendations: Recommendations are for a multi-site study to replicate the validity of the in-class simulation, leveled code blue curriculum, and ACLS certification to facilitate the undergraduate nursing student’s transition into clinical practice. Practice Implications: Nurse response times greatly impact patient outcomes in critical situations. The safe zone of a simulation environment versus clinical practice creates opportunities for students to transition from novice to beginner to competent, while able to make errors and glean reflective knowledge before managing the direct care of a critically ill patient. One critical skill is the ability of a new nurse to identify and quickly respond to the needs of a deteriorating patient. Patient outcomes are improved when nurses launch proficiently from graduation into the transition of the nursing profession.

When to Stop CPR and When to Perform Rhythm Analysis: Potential Confusion Among ACLS Providers.

Health care providers nationwide are routinely trained in Advanced Cardiac Life Support (ACLS), an American Heart Association program that teaches cardiac arrest management. Recent changes in the ACLS approach have de-emphasized routine pulse checks in an effort to promote uninterrupted chest compressions. We hypothesized that this new ACLS algorithm may lead to uncertainty regarding the appropriate action following detection of a pulse during a cardiac arrest. We conducted an observational study in which a Web-based survey was sent to ACLS-trained medical providers at 4 major urban tertiary care centers in the United States. The survey consisted of 5 multiple-choice, scenario-based ACLS questions, including our question of interest. Adult staff members with a valid ACLS certification were included. A total of 347 surveys were analyzed. The response rate was 28.1%. The majority (53.6%) of responders were between 18 and 32 years old, and 59.9% were female. The majority (54.2%) of responders incorrectly stated that they would continue CPR and possibly administer additional therapies when a team member detects a pulse immediately following defibrillation. Secondarily, only 51.9% of respondents correctly chose to perform a rhythm check following 2 minutes of CPR. The other 3 survey questions were correctly answered an average of 89.1% of the time. Confusion exists regarding whether or not CPR and cardiac medications should be continued in the presence of a pulse. Education may be warranted to emphasize avoiding compressions and medications when a palpable pulse is detected.

Validation of a detailed scoring checklist for use during advanced cardiac life support certification.

Defining valid, reliable, defensible, and generalizable standards for the evaluation of learner performance is a key issue in assessing both baseline competence and mastery in medical education. However, before setting these standards of performance, the reliability of the scores yielding from a grading tool must be assessed. Accordingly, the purpose of this study was to assess the reliability of scores generated from a set of grading checklists used by nonexpert raters during simulations of American Heart Association (AHA) Megacodes. The reliability of scores generated from a detailed set of checklists, when used by 4 nonexpert raters, was tested by grading team leader performance in 8 Megacode scenarios. Videos of the scenarios were reviewed and rated by trained faculty facilitators and a group of nonexpert raters. The videos were reviewed "continuously" and "with pauses." The grading made by 2 content experts served as the reference standard, and 4 nonexpert raters were used to test the reliability of the checklists. Our results demonstrate that nonexpert raters are able to produce reliable grades when using the checklists under consideration, demonstrating excellent intrarater reliability and agreement with a reference standard. The results also demonstrate that nonexpert raters can be trained in the proper use of the checklist in a short amount of time, with no discernible learning curve thereafter. Finally, our results show that a single trained rater can achieve reliable scores of team leader performance during AHA Megacodes when using our checklist in a continuous mode because measures of agreement in total scoring were very strong [Lin's (Biometrics 1989;45:255-268) concordance correlation coefficient, 0.96; intraclass correlation coefficient, 0.97]. We have shown that our checklists can yield reliable scores, are appropriate for use by nonexpert raters, and are able to be used during continuous assessment of team leader performance during the review of a simulated Megacode. This checklist may be more appropriate for use by advanced cardiac life support instructors during Megacode assessments than the current tools provided by the AHA.

Deficits in the Provision of Cardiopulmonary Resuscitation During Simulated Obstetric Crises

Objective Previous work suggests the potential for suboptimal cardiopulmonary resuscitation (CPR) in the parturient but did not directly assess actual performance. Study Design We evaluated 18 videotaped simulations of maternal amniotic fluid embolus and resultant cardiac arrest. A checklist containing 10 current American Heart Association recommendations for advanced cardiac life support (ACLS) in obstetric patients was utilized. We evaluated which tasks were completed correctly and the time required to perform key actions. Results Proper compressions were delivered by our teams 56% of the time and ventilations 50% of the time. Critical interventions such as left uterine displacement and placing a firm back support prior to compressions were frequently neglected (in 44% and 22% of cases, respectively). The mean ± SD overall composite score for the tasks was 45 ± 12% (range, 20–60%). The neonatal team was called in a median (interquartile range) of 1:42 (0:44-2:18) minutes:seconds; 15 of 18 (83%) teams called only after the patient was completely unresponsive. Fifty percent of teams did not provide basic information to the neonatal teams as required by neonatal resuscitation provider guidelines. Conclusion Multiple deficits were noted in the provision of CPR to parturients during simulated arrests, despite current ACLS certification for all participants. Current requirements for ACLS certification and training for obstetric staff may require revision.

The Importance of Advanced Cardiac Life Support Certification in Office-Based Surgery

Safety in office-based surgery remains of paramount importance. Accordingly, many consider Advanced Cardiac Life Support training a critical component of safety preparation for office-based surgery. A survey was recently designed and distributed to assess the experience and attitudes of board-certified plastic surgeons toward Advanced Cardiac Life Support training. A two-page, 14-question survey was mailed to the 4581 members of the American Society of Plastic Surgeons. The anonymous survey consisted of multiple choice questions eliciting status of Advanced Cardiac Life Support certification, use of office-based surgery, experience with adverse cardiac and respiratory events, and opinions on mandating Advanced Cardiac Life Support training. The total number of surveys returned was 1461 (32 percent). Current Basic Life Support and Advanced Cardiac Life Support certification was 65.6 percent and 44.9 percent, respectively. Over the past 10 years, 29 percent of plastic surgeons participated in a cardiac or respiratory arrest, and 43.9 percent of these surgeons acted as the code leader; 60.2 percent of plastic surgeons felt Advanced Cardiac Life Support certification should be required, but only 26 percent of these felt it should be mandated to maintain board certification. Historically, Advanced Cardiac Life Support and facility accreditation were strongly recommended but often not required for office-based surgery. The American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery have taken steps to increase patient safety, mandating that outpatient plastic surgery only be performed at accredited facilities. Many credentialing organizations are now escalating the requirements for Advanced Cardiac Life Support/Basic Life Support certification.

Intensive Care in Critical Access Hospitals

Although critical access hospitals (CAHs) have limitations on number of acute care beds and average length of stay, some of them provide intensive care unit (ICU) services. To describe the facilities, equipment, and staffing used by CAHs for intensive care, the types of patients receiving ICU care, and the perceived impact of closing the ICU on CAH staff and the local community. A semistructured interview of directors of nursing at CAHs that provide intensive care services. Two thirds of CAHs that provide intensive care do so in a distinct unit. Most have continuous or computerized electrocardiography and ventilators. Other ICU equipment common in larger hospitals was reported less frequently. Nurse:patient ratio ranged from 1:1 to 1:3, and some or all nursing staff have advanced cardiac life support certification. Most CAHs admit patients to the ICU daily or weekly, primarily treating cardiac, respiratory, gastrointestinal, endocrine, and drug- or alcohol-related conditions. ICUs are also used for postsurgical recovery. Respondents felt that closure of the ICU would be burdensome to patients and families, result in lost revenue, negatively impact staff, and affect the community's perception of the hospital. Intensive care services provided by CAHs fall along a continuum, ranging from care in a unit that resembles a scaled-down version of ICUs in larger hospitals to care in closely monitored medical-surgical beds. Nurse to patient ratio, not technology, is arguably the defining characteristic of intensive care in CAHs. Respondents believe these services to be important to the well-being of the hospital and of the community.

The menu of endoscopic sedation: All-you-can-eat, combination set, á la carte, alternative cuisine, or go hungry

The menu of endoscopic sedation: All-you-can-eat, combination set, á la carte, alternative cuisine, or go hungry

Physician Compliance With Advanced Cardiac Life Support Guidelines

Study objective: To determine compliance with advanced cardiac life support (ACLS) guidelines among ACLS-certified and non-ACLS-certified physicians. Design: Retrospective review of consecutive cardiac arrests between July 1989 and June 1990, including assessment of the resuscitation leaders' ACLS certification. Setting and participants: All nontraumatic prehospital and hospital cardiac arrests in a rural university hospital. Results: Two hundred seven arrests were studied for a total of 436 rhythms with a maximum of 4 rhythms per arrest. There were 78 resuscitations (36.3%) with return of spontaneous circulation. A total of 2,038 interventions were recorded for all rhythms, with 1,320 (64.8%) compliant with ACLS guidelines compared with 718 (35.2%) deviations. Synchronized cardioversion, calcium chloride and sodium bicarbonate were used with significantly higher noncompliance. Ventricular fibrillation had significantly higher mean rhythm deviation scores, whereas scores were significantly lower for sinus rhythm and stable bradycardia ( P<.003). Resuscitations led by ACLS-certified and nonACLS-certified physicians were compared for mean number of deviations per resuscitation attempt, and no differences were found. Resuscitations with return of spontaneous circulation were compared with unsuccessful resuscitations, and there was no difference between groups in controlled deviation scores. No differences could be found between ACLS-certified and nonACLS-certified physicians for return of spontaneous circulation and survival-to-discharge rates. Conclusion: Despite biannual ACLS training of all medical residents and ICU nurses, noncompliance with ACLS guidelines was noted in 35.2% of treatments. We found no correlation between ACLS certification and ACLS guideline compliance. [Cline DM, Welch KJ, Cline LS, Brown CK: Physician compliance with advanced cardiac life support guidelines. Ann Emerg Med January 1995;25:52-57.]

Computerized clinical simulations: a strategy for staff development in critical care

Identifying the learning needs of employees and evaluating the results of staff development offerings are essential elements of the responsibilities of the staff development educator. High patient acuity, the shortage of critical care nurses, and rapidly changing technology within the critical care environment demand the provision of staff development offerings that are appropriate for the learning needs of critical care nurses and the evaluation of the effect of programs on critical care nursing practice. The purposes of this descriptive, correlational study were to compare the ability of a knowledge test, a self-evaluation tool, and computerized clinical simulations to discriminate between nurses with varied levels of knowledge and experience, and to compare the learning needs identified from the three types of evaluative instruments. Each subject (n = 142) completed the Basic Knowledge Assessment Tool for Critical Care, Cardiovascular Self-Evaluation Tool, and four computerized clinical simulations. Both the Basic Knowledge Assessment Tool and the Cardiovascular Self-Evaluation Tool discriminated between experienced/inexperienced and Advanced Cardiac Life Support-certified/noncertified critical care nurses. The computerized clinical simulations discriminated according to Advanced Cardiac Life Support certification, but not between experienced and inexperienced critical care nurses. The computerized clinical simulations identified more specific learning needs than did the Basic Knowledge Assessment Tool or Cardiovascular Self-Evaluation Tool. The evidence for discriminant validity, adequate internal consistency reliability, and ease of administration supports the continued use of these two tools as methods for critical care staff development needs assessment and evaluation. In addition, the study findings support the use of computerized clinical simulations as an adjunct to other needs assessment and evaluation methods in nursing staff development.

Advanced Cardiac Life Support Certification in Ophthalmology

To the Editor. —I recently finished recertification testing for Advanced Cardiac Life Support (ACLS). When I was there, many people were surprised to find out I was an ophthalmology resident. They considered keeping the ACLS certification up-to-date laudable. To me it seemed a logical and responsible thing to do as a citizen and a physician. It made me wonder if other training and practicing ophthalmologists were currently certified in ACLS or felt comfortable implementing its techniques. During the course, I was struck by how distant my recollection of these techniques was only 1 year after performing ACLS regularly. It is unfortunate that many physicians in the niche of ophthalmology have lost skills that are so fundamental to medicine. Who, if not physicians, should feel capable to prevent a family member's unnecessary death from cardiac arrest. Physicians of the community should be prepared to act if severe trauma is met in

Pediatric Emergencies in Office Practices: Prevalence and Office Preparedness

Because of a nationally apparent increased interest in emergency medical services for children and the need for a greater understanding of the relationship between office pediatric and emergency department care of children, a questionnaire was mailed to practitioners to (1) describe office physician involvement with emergent conditions, and (2) evaluate physician office preparedness for pediatric emergencies. Responses were received from 280 pediatricians and family practitioners, including information regarding the availability of equipment and medication, physician training, and practice characteristics. Of the responding physicians, 62% reported that they assessed in their offices more than one child each week who required hospitalization or urgent treatment. A preparedness score was developed and multiple regression analysis was used to investigate the relationship between this score and physician and practice characteristics. The mean overall preparedness score was 53.7 of a possible 156 (range 5 to 136, SD = 31.3). Characteristics related to this score were type of practice and advanced cardiac life support certification. Large multispecialty practices and practices with physicians trained in advanced cardiac life support tended to have better preparedness scores. Family practitioners tended to have more complete stock of medications than pediatricians. The data presented suggested that critically ill children who enter the medical system via the office setting may have a better than even chance of finding the office unprepared to treat the emergency: in fewer than one third of the offices in which it was reported that at least one patient was seen weekly with asthma, anaphylaxis, sickle cell vasoocclusive crisis, status epilepticus, and sepsis were they fully equipped to treat emergencies related to these conditions.(ABSTRACT TRUNCATED AT 250 WORDS)