Introduction to Evidence Based Practice Problem Paper

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Introduction to Evidence Based Practice Problem Paper Herzing University Scholarly Practice, NSG660-7 Dylan Kiser 1-17-2023

My topic of interest is the implementation of a Rapid Response Team in the long-term care and rehab facility that I work for. I have been working on an ambulance for 8 years and worked my fair share of cardiac arrests in that period. I have responded to nursing and rehab facilities that were not performing effective CPR before our arrival severally limiting the likelihood of achieving ROSC for the patient. I had to work my first cardiac arrest at the nursing and rehab facility where I now work and was just blown away at how unorganized that procedure is at these facilities. There were nurses on the unit of the arrest that froze and didn’t know what to do and there were CNAs that had never performed CPR before. When I arrived at the patient’s room no one had started CPR or called for an ambulance to respond to the facility. I had to call for the ambulance, start CPR, and instruct the CNAs how to ventilate the patient with a BVM at the same time. I went to place the patient on an AED, which I found that the facility does not have. Because I felt so strongly about this, I presented the issue as a QI initiative that needed to be investigated and put into place. When looking at the improved quality of care for patients in a pre- hospital setting studies show that for every minute delay of defibrillation there is a 10% less chance of survivability (Medical Advisory Secretariat, 2005) . It is vital to have an AED or a cardiac deflator in place within the first eight minutes of cardiac arrest. The use if an AED could increase the possibility of surviving to 70% (Folke F, 2023) . In addition to AED use proper effective CPR is key to survival of cardiac arrest and the preferred and taught method for healthcare providers by AHA is the Pit-Crew or Team CPR (Dylan Kiser, 2024) . My PICOT style question is composed of the population being long- term care and rehab facility residents, the intervention of adding a Rapid Response Team model to the policies and procedures of sudden cardiac arrest, compared to no such team being in place, looking at the outcome of survivability for the residents when faced with sudden cardiac arrest. This PICOT question will read, in a long-term care and rehab facility does the implementation of a Rapid Response team compared to not using the Rapid Response Team model affect the survivability of sudden cardiac arrest codes?

The articles that I have selected for this EBP QI initiative are the following articles: Outcomes of rapid response team implementation in tertiary private hospitals: a prospective cohort study published October 30,2019 in the International Journal of Emergency Medicine. Quick Safety 32: Crash-cart preparedness published by the Joint Commission. Public access defibrillation: challenges and new solutions published June 29, 2023 in Lippincott Williams & Wilkins Open Access. Evidence-based Medicine and Rapid Response Team Implementation published January 9, 2006 in Mcgill J Med. Even though this article is older than 5 years and is not the most up to date EBP it still holds valuable information for the reasoning of needing the QI initiative and the implementation of RRT’s. It will not be a primary study but will be used for comparison guidelines to further strengthen the argument of utilizing a RRT outside of the hospital setting. My search strategy started as a broad search for articles that related to my frustrations around the night of the code in question. Searching for EBP articles cardiac arrest in the PMC and National Library of Medicine databases. From there I found 20 articles that varied from effective CPR, defibrillation, AED use and access, pre-hospital vs in hospital response, cardiac arrest survivability to discharge, ect. From there I decided to narrow the articles pool down to my main problems faced during that event, being poorly equipped crash carts, lack of AED access, and lack of sufficient trained team members. That narrowing allowed me to select the three primary articles and the older but valuable secondary article mentioned above.

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Reference Akua Owusua Asante, K. A. (2023, July 11). Does the gender of nurses matter to patients? A qualitative analysis of gender preferences of patients . Retrieved from National Library of Medicine : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10338727/#:~:text=Thi s%20is%20because%20women%20have,but%20to%20a%20lesser %20degree. Al-Omari, A. A. (2019). Outcomes of rapid response team implementation in tertiary private hospitals: a prospective cohort study. International Journal of Emergency Medicine volume 12 , 31. Bruckel, J. (2006, January 9). Evidence-based Medicine and Rapid Response Team Implementation . Retrieved from National Library of Medicine : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2687898/ Dylan Kiser, N. (2024, January 17). NR-Paramedic, AHA CPR Instructor . (N. Dylan Kiser, Interviewer) Fariba, K. A., & Gupta., V. (2023, April 24). Involuntary Commitment . Retrieved from National Library of Medicine, StatPerls: https://www.ncbi.nlm.nih.gov/books/NBK557377/ Folke F, S. P. (2023, June 29). Public access defibrillation: challenges and new solutions . Retrieved from National Library of Medicine : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10155700/ Janelle Weise, B. N. (2020, November 20). The NSW Mental Health Act- The difference between a voluntary and involuntary stay in hospital . Retrieved from Easy read information on public mental health services in New South Wales: https://www.3dn.unsw.edu.au/sites/default/files/documents/3DN_MHA_ VoluntaryVsInvoluntary_ERv1.pdf Medical Advisory Secretariat. (2005, December 1). Use of Automated External Defibrillators in Cardiac Arrest . Retrieved from National Library of Medicine : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3382296/#:~:text=With %20each%20minute%20delay%20in,survival%20outcomes%20in %20these%20patients. Psy.D., D. S. (2019, November 1). What to Expect If You Need Inpatient Hospitalization . Retrieved from Deprission: https://www.psychologytoday.com/us/blog/two-takes-depression/20191 1/what-expect-if-you-need-inpatient-hospitalization#:~:text=Once %20admitted%2C%20you%27ll%20find,see%20you%20at%20a %20time. The Joint Commission. (n.d.). Quick Safety 32: Crash-cart preparedness . Retrieved from Quick Safety: https://www.jointcommission.org/resources/news-and-multimedia/news letters/newsletters/quick-safety/quick-safety-issue-32-crashcart- preparedness/crashcart-preparedness/

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