Proposed Topic (Most preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Proposed Topic (Second preferred): :
Staff Engagement and Empowerment (motivating staff / teamwork / work revamp tackling manpower issue / staff wellness / OSH / retention)
Authors (including presenting author) :
Kwan KY(1), Leung YW(2), Choi WK(1), Yue CS(1), Ng YB(1).
Affiliation :
(1)Division of Cardiology, Department of Medicine and Geriatrics, United Christian Hospital, (2) Nursing Services Division, United Christian Hospital.
Introduction :
Defibrillation is essential in “chain of survival” of in-hospital resuscitation; much higher survival rate is achieved with prioritizing defibrillation for shocking rhythm and initial cardiopulmonary resuscitation (CPR). Cardiac rehabilitation (CR) reduces recurrent cardiovascular event and its mortality after revascularization. Patients are at risk of arrhythmia during stress CR training. Experience from our past CPR drill, earliest response time from witnessed arrest to manual defibrillation was 6 minutes; whereas chance of survival drops by 7-10% per minute without bystander CPR.
Objectives :
Shorten time to defibrillation prior to advanced life support rescuer arrival. Enhance staff’s competence of using semi-automated external defibrillator (SAED) for defibrillation.
Methodology :
Early defibrillation using SAED by accredited therapists in our CR Centre is authorized by our Division of Cardiology under periodical review, when advanced life support rescuer is not readily available on-site for CPR during CR program. 2-hour workshop with theoretical lecture and scenario-based practice had been held annually since 2022. Targeted participants were physiotherapists and occupational therapists who were Basic Life Support providers with service covering cardiac rehabilitation. Electronic survey about staff’s competency and knowledge test of using SAED were performed before and after workshop.
Result & Outcome :
Total 11 therapists were authorized to use SAED in CR Centre after training. Time to defibrillation using SAED by therapists was markedly shortened to 1 minute 48 seconds in CRP drill 2023. All therapists agreed that early defibrillation was crucial for witnessed cardiac arrest. However, they could not implement early defibrillation before. Major barriers included liability, anxiety, inadequate training and equipment concerns. Staff’s competence level had been significantly empowered from 5 to 9 using 10-point scale after training. While automated external defibrillator can be used by anyone at anywhere, SAED is not well utilised in hospital where cardiac arrest often happens with most staffs are BLS providers. Instilling competence with adequate training allows us to act swiftly and save lives. Such intuitive visual-verbal prompting practice can be further promulgated in clinical areas where cardiac arrest seldom found with low staff’s competence.
