The Effect of Cardiopulmonary Resuscitation Clinical Audit on the Patient Survival in the Emergency Room

Document Type: Original Article

Authors

1 Department of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran

2 Department of Trauma Research Center and Department of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran

3 Department of Behavioral Sciences Research Center, Department of nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran

4 Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

Abstract

Background: The ability to perform cardiopulmonary resuscitation (CPR) is among the most important professional skills for physicians and nurses. There is a wide difference among different countries respecting resuscitation success rate. Studies show weaknesses in performing resuscitation. Objectives: This study aimed at assessing the effects of clinical audit of CPR in the emergency room based on the Situation Stabilization Model (SSM). Materials and Methods: This quasi‑experimental study was done in 2017 in the emergency room of Baqiyatallah Hospital, Tehran, Iran. Using the Adib checklist, 35 resuscitations were assessed based on the steps of clinical audit. Then, a 1‑month educational program was held for the resuscitation staffs in the study setting. Then, 35 new resuscitations were assessed using the same checklist. Finally, the results of the two measurements were compared. Results: There were significant differences between two measurement time points regarding the mean scores of different resuscitation skills (P < 0.001). Primary resuscitation success rate increased from 6 (17.1%) cases at baseline to 8 (22.9%) of the cases after the intervention. This increase was not statistically significant (P = 0.47). Conclusions: Clinical audit in the emergency room based on the SSM improves the quality and the success rate of CPR. The success rate is in our study increased. Furthermore, the reported data were not statistically significant for improving the success rate; it is clinically important. Because primary resuscitation success rate increased from 6 (17.1%) cases at baseline to 8 (22.9%) cases after the intervention. These findings highlight the necessity and the importance of the clinical audit of care services as well as the implementation of educational interventions based on the existing weaknesses. Given the great importance and sensitivity of resuscitation, health‑care staffs need to receive regular theoretical and practical in‑service resuscitation‑related training.

Keywords


1. Ibrahim WH. Recent advances and controversies in adult cardiopulmonary resuscitation. Postgrad Med J 2007;83:649‑54.

2. Miranzadeh S, Adib‑Hajbaghery M, Hosseinpour N. A prospective study of survival after in‑hospital cardiopulmonary resuscitation and its related factors. Trauma Mon 2016;21:e31796.

3. Mehra R. Global public health problem of sudden cardiac death. J Electrocardiol 2007;40:S118‑22.

4. Mundell WC, Kennedy CC, Szostek JH, Cook DA. Simulation technology for resuscitation training: A systematic review and meta‑analysis. Resuscitation 2013;84:1174‑83.

5. Mahoori A, Hassani E, Noroozinia H, Amiri Kar M. Evaluating the knowledge of Urmia university medical students about adult cardiopulmonary resuscitation. Urmia Med J 2010;21:260‑5.

6. Mäkinen M, Axelsson A, Castrén M, Nurmi J, Lankinen I, Niemi‑Murola L, et al. Assessment of CPR‑D skills of nursing students in two institutions: Reality versus recommendations in the guidelines. Eur J Emerg Med 2010;17:237‑9.

7. Josipovic P, Webb M, McGrath I. Basic life support knowledge of undergraduate nursing and chiropractic students. Aust J Adv Nurs 2009;26:58.

8. Kumari KM, Amberkar MB, Alur SS, Bhat PM, Bansal S. Clinical awareness of do’s and don’ts of cardiopulmonary resuscitation (CPR) among university medical students – A questionnaire study. J Clin Diagn Res 2014;8:MC08‑11.

9. Borimnejad L, Nikbakht Nasrabadi A, Mohammadi Mohammadi H. The effect of cardiopulmonary resuscitation workshop on nurses’ sustained learning. Iran J Med Educ 2008;7:209‑15.

10. Khoshrang H, Heidarzadeh A, Asadi A. Assessment of the effects of education in clinical skills center on cardiopulmonary resuscitation knowledge of physicians and nurses working in educational therapeutic centers of guilan university of medical sciences in 2004. Res Med Educ 2007;7:7‑13.

11. Adib‑Hajbaghery M. Longitudinally investigation of the skills of cardiopulmonary resuscitation in nurse interns of Kashan University of Medical Sciences. Iran J Cardiovasc Nurs 2014;3:6‑17.

12. Bekhradian N, Khalili A, Bargrizan S, Motlagh AH, Paymard A, Vahdatnejad J. Comparison of knowledge of medical and paramedical intern about of CPR, 2015. Health Sci 2016;5:128‑31.

13. Omidifar N, Yamani N, Changiz T. The efficacy of new method of cardiopulmonary resuscitation training in promoting knowledge and skills of 4th year medical students. Iran J Med Educ 2008;8:23‑31.

14. GoodarziA, JalaliA, AlmasiA, NaderipourA, KalhoriiRP, KhodadadiA. Study of survival rate after cardiopulmonary resuscitation (CPR) in hospitals of Kermanshah in 2013. Glob J Health Sci 2014;7:52‑8.

15. Salari A, Mohammadnejad E, Vanaki Z, Ahmadi F. Survival rate and outcomes of cardiopulmonary resuscitation. J Crit Care Nurs 2010;3:1‑2. 16. McKibbon KA. Evidence‑based practice. Bull Med Libr Assoc 1998;86:396‑401.

17. Dolatabadi AA, Setayesh A, Zare M, Hosseinnejad A, Bozorgi F, Farsi D. Descriptive analysis of contributing factors in outcomes of emergency department CPRs. Crit Care 2005;9:P302.

18. Idris AH, Guffey D, Pepe PE, Brown SP, Brooks SC, Callaway CW, et al. Chest compression rates and survival following out‑of‑hospital cardiac arrest. Crit Care Med 2015;43:840‑8.

19. Razi RR, Churpek MM, Yuen TC, Peek ME, Fisher T, Edelson DP, et al. Racial disparities in outcomes following PEA and asystole in‑hospital cardiac arrests. Resuscitation 2015;87:69‑74.

20. Shamsi V, Mahmoudi H, Sirati Nir M, Babatabar Darzi H. Effect of job specialization on the hospital stay and job satisfaction of ED nurses. Trauma Mon 2016;21:e25794.

21. Moayed MS, Mahmoudi H, Ebadi A, Sharif Nia H. Stress and fear of exposure to sharps in nurses. Iran J Psychiatry Behav Sci 2016;10:e3813. 22. Mahmoudi H, Mohammadi E, Ebadi A, Taheri F. Stabilizing the situation in an emergency ward: A grounded theory study of how emergency nurses provide care in emergency wards. Crit Care Nurs J 2017;10:e11603.

23. Moayed MS, Mahmoudi H, Ebadi A, Salary MM, Danial Z. Effect of education on stress of exposure to sharps among nurses in emergency and trauma care wards. Trauma Mon 2015;20:e17709.

24. Levy B, Rockall T. The role of clinical audit in clinical governance. Surgery (Oxford). 2009;27:367‑70.

25. Vahidi RG, Tabrizi JS, Iezadi S, Gholipour K, Mojahed F, Rasi V. Organizational facilitators and barriers to implementing effective clinical audit: Systematic review. Journal of Pakistan Medical Students 2013;3:38-45.

26. Kavosi A. Effect of continuing education competency‑based program for emergency nurses on rate CPR successful. Q J Nurs Manage 2015;4:19‑28.

27. Asadi HK, Pollard J. Fully successful resuscitation despite prolonged cardiac arrest. Saudi J Anaesth 2011;5:314‑6.

28. Safari S, Tabrizi JS, Rouhi AJ, Sadeghi‑Ghyassi F, Ghojazadeh M, Rouhi AH, et al. Family members’ attitudes regarding family presence during resuscitation of adults: A systematic review and meta analysis. Ann Anesthesiol Crit Care 2016;1:e10204. DOI: 10.5812/aacc.10204.

29. Kohpaye Zadeh J, Mehrabi H, Ranjbar H, Shoghi M, Zeighami Mohammadi S. The effect of multi‑media educational software on learning basic principles of cardio‑pulmonary resuscitation (CPR) in nursing students. J Crit Care Nurs 2014;7:160‑7.

30. Dal U, Sarpkaya D. Knowledge and psychomotor skills of nursing students in North Cyprus in the area of cardiopulmonary resuscitation. Pak J Med Sci 2013;29:966‑71.

31. Salari A, Mohammad Nejad E, Vanaki Z, Ahmadi F. Effect of in‑hospital cardiopulmonary cerebral resuscitation management on resuscitation outcomes. J Crit Care Nurs 2011;4:13‑22.

32. Assar S, Husseinzadeh M, Nikravesh AH, Davoodzadeh H. The success rate of pediatric in‑hospital cardiopulmonary resuscitation in Ahvaz training hospitals. Scientifica (Cairo) 2016;2016:9648140.

33. Peberdy MA, Kaye W, Ornato JP, Larkin GL, Nadkarni V, Mancini ME, et al. Cardiopulmonary resuscitation of adults in the hospital: A report of 14720 cardiac arrests from the national registry of cardiopulmonary resuscitation. Resuscitation 2003;58:297‑308.

34. Eftychiou C, Georgiou M, Andreou A, Michaelides A, Yiangou K, Deligeorgis A, et al. Nicosia general hospital cardiac arrest team: First year’s practice and outcomes of in‑hospital resuscitation. Hellenic J Cardiol 2009;50:264‑8.

35. Singh S, Namrata AG, Gautam PL, Luthra N, Tanwar G, Kaur A. Evaluation of cardiopulmonary resuscitation (CPR) for patient outcomes and their predictors. J Clin Diagn Res 2016;10:UC01‑4.

36. Fennelly NK, McPhillips C, Gilligan P. Arrest in hospital: A study of in hospital cardiac arrest outcomes. Ir Med J 2014;107:105‑7.

37. Cooper S, Janghorbani M, Cooper G. A decade of in‑hospital resuscitation: Outcomes and prediction of survival? Resuscitation 2006;68:231‑7.

38. Ozcan V, Demircan C, Engindenizi Z, Turanoglu G, Ozdemir F, Ocak O, et al. Analysis of the outcomes of cardiopulmonary resuscitation in an emergency department. Acta Cardiol 2005;60:581‑7.

39. Gombotz H, Weh B, Mitterndorfer W, Rehak P. In‑hospital cardiac resuscitation outside the ICU by nursing staff equipped with automated external defibrillators – The first 500 cases. Resuscitation 2006;70:416‑22.