Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Tang PY, Law KL, Lee SPP, Lam KN, Sun TFD
Affiliation :
Hospital Resuscitation Sub-Committee, North District Hospital, Hospital Authority, Hong Kong
Introduction :
Timely defibrillation is pivotal in cardiac arrest, significantly impacting patient outcomes. The use of Automated External Defibrillators (AEDs) in out-of-hospital cardiac arrest has demonstrated improved survival rates. The rising awareness about the significance of early defibrillation and the user-friendly nature of AEDs has made them increasingly popular, even among lay rescuers. In the hospital setting, nurses often serve as the first responders to cardiac arrest situations. They play a critical role in providing immediate intervention, particularly when access to a physician or specialized resuscitation team may be delayed. However, nurses are typically not authorized to perform manual defibrillation in Hong Kong without specific training and supervision.
Objectives :
To propose the implementation of Nurse-Led Defibrillation (NLD) using AED-capable defibrillators, empowering our nurses to initiate early defibrillation, aims to enhance the efficiency and effectiveness of resuscitation efforts and, ultimately improving patient outcomes in in-hospital cardiac arrest.
Methodology :
The pilot program, NLD-AED mode, was launched since 2021, necessitates a cultural shift beyond knowledge and skills. The Hospital Resuscitation Sub-committee oversees the project, supported by top management. Training targets the in-charge nurses, including theory, hands-on practice, simulations, and knowledge quizzes. Communication efforts involve updating trained nurse lists, displaying procedure cue cards, and integrating NLD-AED in CPR drill audits.
Result & Outcome :
From October 2021 to December 2023, 311 frontline nurses (90% of in-charge nurses) were trained, expressing readiness for this empowered role. NLD-AED mode was successfully initiated in 39 witnessed cardiac arrests, particularly during the night and in the absence of physicians. Six shockable rhythm cases resulted in successful NLD by trained nurses, with five achieving spontaneous circulation and positive patient outcomes. Both nurses and doctors’ feedback of this initiative were good. The nurses accepted this empowered role positively and the doctors appreciated that the NLD-AED would definitely help and improve patient outcomes. In conclusion, experience underscores the impact of "Early Defibrillation Saves Lives." Empowering nurses in AED use during in-hospital cardiac arrest, especially in the absence of doctors, is crucial to minimize delays in defibrillation for shockable cardiac arrest. Plans involve interactive e-learning for continuous education and regular case reviews to identify areas for improvement. Ongoing data collection, including rates of return of spontaneous circulation (ROSC) and survival, will evaluate program effectiveness. This initiative enhances patient outcomes and establishes nurses as key contributors to timely and effective resuscitation efforts.
