Cardiac Surgery Unit Advanced Life Support (CSU-ALS). Change in practice. Staff education and major improvement in patient resuscitation after open heart surgery
Location
Central Division
Start Date
26-10-2023 10:40 AM
End Date
26-10-2023 10:45 AM
Description
Abstract:
Title: Adopting best practices for cardiac critical care nurses providing resuscitation to patients post-open heart surgery
Author: Kostyuk, S., Burton, T., Takano, S.
Site: Providence St. Vincent Medical Center, CICU
Purpose: To describe the impact of a cardiac training session on nurses’ knowledge, confidence, and practices providing resuscitation post-open heart surgery.
Background: In 2015, the Society of Thoracic Surgeons released the Cardiac Surgery Unit Advanced Life Support (CSU-ALS) outlining best practice for resuscitating patients after open-heart surgeries. CSU-ALS actions are significantly different standard resuscitation practices. CSU-ALS directs several complex actions: early defibrillation with three stacked shocks administered before cardiac compressions are given, early identification of unstable bradycardia with pacing, minimizing use of Epinephrine, prompt re-sternotomy within 5 minutes of cardiac arrest, using compressions to achieve systolic blood pressure of 60 mm/hg, and use of internal massage. The survival rate of patients post-open heart surgery who experience cardiac arrest is significantly improved with CSU-ALS compared to prior resuscitation practices. In a cardiac intensive care unit (CICU) in a large medical center, the CSU-ALS guidelines were not known or practiced among nurses.
Methods: To implement the CSU-ALS practices and improve nursing knowledge and confidence with the practice change, we developed a comprehensive, evidence-based practice educational program, including a didactic paired with hands-on simulation training using manikins. In 2022, the new two-hour, mandatory open chest code education was provided in the CICU simulation lab. The new classes were offered many times over the year to ensure all nurses could attend a session. CICU nurses were given a confidence questionnaire before and after the training. Nursing confidence identifying and executing eight different components of the CSU-ALS protocol was measured with eight unique self-assessment questions where response options included: “not confident”, “somewhat confident”, “confident”, or “very confident”.
Results: A total of eighty-five CICU nurses participated with varying CICU experiences. Before education was provided, 38% of the nurses evaluated themselves as “not confident at all” and only 20% rated themselves as at least “confident” with the CSU-ALS. After the education was provided, nurses’ confidence increased dramatically: 87% of nurses felt at least “confident” about running an open chest code and 0% rated themselves “not confident” at all.
Conclusions: Staff education, including hands-on simulation, improves understanding and performance of in-hospital cardiac arrest resuscitation for open-heart patients, leading to improved adherence to the ACU-CLS guidelines. The ACU-CLS evidence-based protocol for open-chest cardiac arrest differs dramatically from current practice for advanced cardiac life support, yet for the specialized open-heart surgery population, following the CSU-ALS protocol significantly favors patient survival rates. Our evidence-based practice training session resulted in significant increases in nursing confidence and knowledge of the CSU-ALS guidelines, supporting nursing change in practice during the high-risk, low-volume procedure of open chest patient resuscitation.
Implications for Practice: Providing specialized, evidence-based practice training on how to resuscitate patients post-open heart surgery significantly improves nursing confidence and knowledge of the process. Knowledge and confident nurses will practice the evidence-based CSU-ALS guidelines, leading to significantly reduced patient mortality rates. The accuracy of nursing knowledge is crucial for patients' survival. The next steps include providing annual training for the nurses to ensure sustained competency and confidence and promote patient safety.
Recommended Citation
Kostyuk, Svitlana; Burton, T; and Takano, S, "Cardiac Surgery Unit Advanced Life Support (CSU-ALS). Change in practice. Staff education and major improvement in patient resuscitation after open heart surgery" (2023). Central Division Nurse Clinical Inquiry Conference. 24.
https://digitalcommons.providence.org/central_nurs_conf/2023/agenda/24
Cardiac Surgery Unit Advanced Life Support (CSU-ALS). Change in practice. Staff education and major improvement in patient resuscitation after open heart surgery
Central Division
Abstract:
Title: Adopting best practices for cardiac critical care nurses providing resuscitation to patients post-open heart surgery
Author: Kostyuk, S., Burton, T., Takano, S.
Site: Providence St. Vincent Medical Center, CICU
Purpose: To describe the impact of a cardiac training session on nurses’ knowledge, confidence, and practices providing resuscitation post-open heart surgery.
Background: In 2015, the Society of Thoracic Surgeons released the Cardiac Surgery Unit Advanced Life Support (CSU-ALS) outlining best practice for resuscitating patients after open-heart surgeries. CSU-ALS actions are significantly different standard resuscitation practices. CSU-ALS directs several complex actions: early defibrillation with three stacked shocks administered before cardiac compressions are given, early identification of unstable bradycardia with pacing, minimizing use of Epinephrine, prompt re-sternotomy within 5 minutes of cardiac arrest, using compressions to achieve systolic blood pressure of 60 mm/hg, and use of internal massage. The survival rate of patients post-open heart surgery who experience cardiac arrest is significantly improved with CSU-ALS compared to prior resuscitation practices. In a cardiac intensive care unit (CICU) in a large medical center, the CSU-ALS guidelines were not known or practiced among nurses.
Methods: To implement the CSU-ALS practices and improve nursing knowledge and confidence with the practice change, we developed a comprehensive, evidence-based practice educational program, including a didactic paired with hands-on simulation training using manikins. In 2022, the new two-hour, mandatory open chest code education was provided in the CICU simulation lab. The new classes were offered many times over the year to ensure all nurses could attend a session. CICU nurses were given a confidence questionnaire before and after the training. Nursing confidence identifying and executing eight different components of the CSU-ALS protocol was measured with eight unique self-assessment questions where response options included: “not confident”, “somewhat confident”, “confident”, or “very confident”.
Results: A total of eighty-five CICU nurses participated with varying CICU experiences. Before education was provided, 38% of the nurses evaluated themselves as “not confident at all” and only 20% rated themselves as at least “confident” with the CSU-ALS. After the education was provided, nurses’ confidence increased dramatically: 87% of nurses felt at least “confident” about running an open chest code and 0% rated themselves “not confident” at all.
Conclusions: Staff education, including hands-on simulation, improves understanding and performance of in-hospital cardiac arrest resuscitation for open-heart patients, leading to improved adherence to the ACU-CLS guidelines. The ACU-CLS evidence-based protocol for open-chest cardiac arrest differs dramatically from current practice for advanced cardiac life support, yet for the specialized open-heart surgery population, following the CSU-ALS protocol significantly favors patient survival rates. Our evidence-based practice training session resulted in significant increases in nursing confidence and knowledge of the CSU-ALS guidelines, supporting nursing change in practice during the high-risk, low-volume procedure of open chest patient resuscitation.
Implications for Practice: Providing specialized, evidence-based practice training on how to resuscitate patients post-open heart surgery significantly improves nursing confidence and knowledge of the process. Knowledge and confident nurses will practice the evidence-based CSU-ALS guidelines, leading to significantly reduced patient mortality rates. The accuracy of nursing knowledge is crucial for patients' survival. The next steps include providing annual training for the nurses to ensure sustained competency and confidence and promote patient safety.
