Media Annotation: Analysis of Code Blue Simulation Video for CPR Training
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This media annotation analyzes a Code Blue Simulation video for CPR training, evaluating its adherence to ARC guidelines and identifying strengths and weaknesses. The video's quality, strengths, weaknesses, and recommendations for practice change are discussed.
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MEDIA ANNOTATION
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Introduction The Christiana Care Health System's Code Blue Simulation program offers virtual training for health practitioner and nurses. The video 1 has been used for the analysis, depicts a patient room where the patient is seen not responding briefly after his admission as he suffers massive cardiac arrest. In the current scope of media annotation, the performance of the skill according to ARC guidelines and strengths as well as weakness of the video will be evaluated. After reviewing the video is several areas, varied positive and negative issues were identified, which has been discussed based on the available evidence (Christiana Care, 2011). Performance as per ARC guidelines The video depicts a patient not responding 5 minutes post interaction and has suffered massive cardiac arrest. The nursing leader calls for immediate assistance and takes their own position in recovering the patient. The ARC Guideline 8 of Cardiopulmonary Resuscitation (CPR) is applicable in this case as the patient was not breathing and did not respond (Australian Resuscitation Council, 2019). The Australian and New Zealand Committee on Resuscitation (ANZCOR) provides, healthcare professionals or rescuers need to immediately initiate CPR in case the patient is unresponsive. The video actively encourages bystanders to be actively engaged in CPR.According to Deasy et al (2012), the compression-to-ventilation ratio needs to be 30:2 for the patient. The defibrillator of 200 was given to the patient to recover the patient. Analysis of the Video for Quality The quality of the video was high, which was suitable for training. The video progressed gradually and each stage was followed by the rescuer in an appropriate manner. All medical terms and terminologies were adequately depicted in the video. The video depicted all processes 2
that need to be followed for CPR. The aim of the entire video was to reduce breaks in the chest compressions. The Videos Strengths The most interesting part of the video is the leadership that is depicted to rescue the patient. The video provides an appropriate training procedure for patient suffering CPR. The healthcare staffs immediately responded to get the patient back to normal breathing(ANZICS- CORE MET dose Investigators, 2012). The most important aspect that is shown in the video is that the defibrillator is put on the chest until the patient is charged and ready to get shocked. The focus should be on reducing time off the chest. Boyde, Padget, Burmeister, and Aitken (2013) journal evaluated cardiac arrest results post the designing of the Australian Resuscitation Council (ARC) 2006 changed format for providing simple along with advanced systems in life support. Post application of ARC 2006 guidelines, these factors are important, such as providing an initial shock rhythm, along with shorter length of resuscitation, and shorter length of time initiating from collapse to the arrival of the cardiacarrest team(Courtney & McCutcheon, 2010).The paper depicted significant prognostic factors with no significant changes in the return in spontaneous circulation (ROSC) or survival to discharge. As the study depicts multiple factor influences which affects clinical outcomes to post in-hospital cardiac arrest (Deasy et al, 2011). The video also depicts the initial shock rhythm with shorter length of resuscitation, hence these multiple factors can influence clinical outcomes to improvise outcomes. Ehlenbach et al (2009) state that the rate of survival post-in-hospital cardiopulmonary resuscitation (CPR) improved post application of ICD-9 codes. It states that do-not-resuscitate 3
(DNR) was common in the 1980s. However, the frequency of administration of CPR for the patient, that is unlikely to gain from resuscitation. With an increase in the proportion of in- patient, deaths are preceded by CPR. The article reflects a higher rate of survival post CRP. The videodepictstheeffectivemanagementofpatientoutcomethroughthemanagementof outcomes. Nehme et al (2015) depict the quality of the emergency services in medical care in the Australian Southeastern state of Victoria. An enhancement in cardiopulmonary resuscitation with survival outcome for the out-of-hospital patient in cardiac arrest inpatient in Victoria, Australia. Survival outcomes and bystander CPR in Victoria, CPR can contribute to partly in delays in implementing an electronic call-taking process. The video has also supported by the patient outcome Mader (2009) states that a delay in defibrillation is associated with poor survival rates in- hospital cardiac arrest. The degree to which hospitals undertake defibrillation response time though is unknown but remains unknown. In the video, the healthcare staffs appropriately applied defibrillation and got the patient's heartbeat. Chan,Nichol,Krumholz,Spertus,andNallamothu(2009)statesthatdelaysto defibrillations are seen connected with worse rates of survival post after-in-hospital cardiac arrest. However, the degree with which hospitals apply defibrillation response times affects patient survival rates (Daly, Speedy & Jackson, 2017). Delayed defibrillation rates vary amongst hospitals and better defibrillation provides outcomes of improvised patient outcomes. The video also depicts good response time, within 5 minutes, where the patient recovery team arrived and tried to recover the patient. 4
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The Videos Weaknesses The video has certain weaknesses as well. None of the healthcare professionals checked the pulse of the patient. The ABC of CPR was not adequately followed. CPR requires an emergency procedure to be followed for the patient, who has witnessed a severe cardiac arrest. The ABC of CPR would have provided an appropriate step and guideline to improve patient outcome, which was not a part of the video.The technique of CPR compression was not good, it was bad as the speed of compression was not fast enough. It was noted that the depth of the compression was inadequate on multiple occasions, for example at first 30 seconds time of the video. Moreover the depth of compression has to be a minimum of 5 cm for generating cardiac output,whichwasnotadheredto.Severalresearcheshasindicatedtheimportanceof compression during cardiac arrest. Further, the patient's Code status was not adequately disclosed. The Code status of the patient would have reflected the level of emergency and other details connected with the patient, which was not disclosed. Therefore, people watching the video for the purpose of training will not be able to adequately follow and adhere to the guidelines in an appropriate manner. Moreover, it is not possible to ascertain the V-fib status of the patient from only one pad attached.Klocko (2009) provides the latest CPR guidelines has provided enhanced cardiac arrest outcomes. The Standards for Cardiopulmonary Resuscitation and Emergency Cardiac Care introduction in cardiac care. This article provides a standardized compression-to-ventilation ratio of30:2 for all ages. As earlier higher rates of ventilation caused hyperventilation. Checking of pulse rates was considered to be mandatory for a better outcome. The recommended ventilation rates were decreased to 10 to 12 breaths per minute or 8 per minute in the advanced airway in 5
place. Determining pulse rate was considered to be integral as it was deemed essential to perform CPR on a person who has a pulse as against a person, who was pulseless. Becket al (2016) state that it is integral to administer IV to the patient, faced with CPR. However,thisvideolackedsignificantlyinthisdomainasnoneofthehealthcarestaff administered IV on him. There was no record or mention of fluids that was provided to him. Herrington, Zardins & Hamilton (2013) includes ways in which Emergency Telehealth Service (ETS) was established and used in Western Australia. Though this journal includes ways in which telehealth was used to provide emergency telemedicine by nurses where they could not easily reach, the most important contribution of this work is in ways clinical problems were treated and diagnosed to provide care to the patient. The work reflects that depth of compression needed during a cardiac arrest isat least 5 cm, whereasthe video depictedinadequate compression on several occasions. A minimum of 5 cm compression is necessary for generating a quick response in cardiac output. Though the video showed final attaining of success for the patient case, however, the medical procedure followed was inadequate. Pulse rate check is a protocol which is mandatory for healthcare providers in cardiac arrest, however, the video did not depict checking of the pulse for the patient. Further interruptions in CPR needs to be minimized as much as possible, as stated in the article. However, the video depicted interruptions in CPR as the healthcare providers waited for response time from the leader to provide them with orders. Ventilation within the initial 4 minutes of a ventricular tachycardia or ventricular fibrillation(VT/VF)arrestislesscritical.Inearlydefibrillation,VT/VFisessentialfor enhancement of patient outcome. However, the ventilation given to the patient was 2 minutes, which was far higher when considered against the existing standards. 6
Ramelet, Gill, and Group (2012) rightly point out that shock to be given to the patient in case of a CPR needs to be in the range of 100-120 J in the first round. However, the video mentioned the first shock given to the patient was 200 J was too much. Moreover, the machine was showing that it was delivering a 5J shock, which was against the standard that was mentioned (Duffield et al, 2011). Recommendation for Practice Change The video depicts appropriate steps being followed in order to recover the patient, however, the dangers of the weaknesses need to be realized. The recommended practice for change includes the following; The CPR compression needs to be faster than what is depicted in the video. The CPR needs to be initiated without raising concerns regarding harm to the person. Monitoring of the patient’s pulse rate could have provided better adherence to guidelines as stated. However, the patient’s pulse rate was not at all monitored. Another recommendation is that the CPR compression should be harder. The risk of injury during CPR administration has to be determined. The patient should have been provided IVF to stabilize and recover the patient. Providing IVF to patient's, in this case, is a protocol deemed essential, which has been totally ignored. Conclusion To conclude, it can be said that the quality of the video and the overall response is good. However, there were several weaknesses associated with the video as well. The major lack of the video is the response time and the pace at which the patient treatment follows. But the CPR is 7
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continued until a strong pulse is felt and then it is decided to transfer the patient is decided to be transferred to the ICU. Thus, the video communicates several relevant strengths, which are relevant for training nurses with certain weaknesses as well. References ANZICS-COREMETdoseInvestigators.(2012).RapidResponseTeamcomposition, resourcingandcallingcriteriainAustralia.Resuscitation,83(5),563-567.doi: 10.1016/j.resuscitation.2011.10.023.Retrievedfrom https://www.sciencedirect.com/science/article/abs/pii/S0300957211006265 AustralianResuscitationCouncil.[2019].TheARCGuidelines.Retrievedfrom <https://resus.org.au/guidelines/> Beck, B., Tohira, H., Bray, J.E., Straney, L., Brown, E., Inoue, M., Williams, T.A., McKenzie, N., Celenza, A., Bailey, P. and Finn, J. (2016). Trends in traumatic out-of-hospital cardiac arrest in Perth, Western Australia from 1997 to 2014.Resuscitation,98, 79-84. doi:10.1016/j.resuscitation.2015.10.015.Retrievedfrom https://www.sciencedirect.com/science/article/abs/pii/S0300957215008795 8
Boyde, M. S., Padget, M., Burmeister, E., & Aitken, L. M. (2013). In-hospital cardiac arrests: effect of amended Australian Resuscitation Council 2006 guidelines.Australian Health Review,37(2),178-184.doi:10.1071/AH11112.Retrievedfrom http://www.publish.csiro.au/ah/ah11112 Chan, P. S., Nichol, G., Krumholz, H. M., Spertus, J. A., & Nallamothu, B. K. (2009). Hospital variation in time to defibrillation after in-hospital cardiac arrest.Archives of internal medicine,169(14), 1265-1273. doi: 10/1001/archinternmed.2009.196.Retrieved from https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/224683 Christiana Care. [May 5, 2011].Code Blue Simulation – Virtual Education and Simulation Training Center. Retrieved from <https://www.youtube.com/watch?v=chMd3jjfrmo> Courtney, M., & McCutcheon, H. (Eds.). (2010).Using evidence to guide nursing practice. Australia,Victoria:ElsevierHealthSciences.2e.Retrievedfrom https://books.google.co.in/books? hl=en&lr=&id=8ONgRpWh7SAC&oi=fnd&pg=PP1&dq=Australia+nursing+leader&ots =-ey6CM5n8_&sig=SoIMCVACizNEInZ8U0NcNJwntZc#v=onepage&q=Australia %20nursing%20leader&f=false Daly, J., Speedy, S., & Jackson, D. (2017).Contexts of nursing: An introduction. Australia: Elsevier Health Sciences. 5thEdition. Retrieved fromhttps://books.google.co.in/books? hl=en&lr=&id=xmclDwAAQBAJ&oi=fnd&pg=PP1&dq=Australia+nursing+leader&ots =_LNEFXuGSn&sig=iC5jd-ijueL8FeXAOK0wWMRdz3s#v=onepage&q=Australia %20nursing%20leader&f=false 9
Deasy, C., Bray, J. E., Smith, K., Harriss, L. R., Bernard, S. A., Davidson, P. M., & Cameron, P. (2012). Resuscitation of out-of-hospital cardiac arrests in residential aged care facilities inMelbourne,Australia.Resuscitation,83(1),58-62.doi: 10.1016/j.resuscitation.2011.06.030.Retrievedfrom https://www.sciencedirect.com/science/article/abs/pii/S0300957211004060 Deasy, C., Bray, J. E., Smith, K., Harriss, L. R., Bernard, S. A., Cameron, P., & VACAR Steering Committee. (2011). Out-of-hospital cardiac arrests in the older age groups in Melbourne,Australia.Resuscitation,82(4),398-403.doi: 10.1016/j.resuscitation.2010.12.016.Retrievedfrom https://www.sciencedirect.com/science/article/abs/pii/S0300957211000074 Duffield, C., Diers, D., O'Brien-Pallas, L., Aisbett, C., Roche, M., King, M., & Aisbett, K. (2011).Nursingstaffing,nursingworkload,theworkenvironmentandpatient outcomes.Applied nursing research,24(4), 244-255. doi: 10.1016/j.apnr.2009.12.004. Retrieved fromhttps://www.sciencedirect.com/science/article/pii/S0897189709001311 Ehlenbach, W. J., Barnato, A. E., Curtis, J. R., Kreuter, W., Koepsell, T. D., Deyo, R. A., & Stapleton,R.D.(2009).Epidemiologicstudyofin-hospitalcardiopulmonary resuscitation in the elderly.New England Journal of Medicine,361(1), 22-31.doi: 10.1056/NEJMoa0810245.Retrievedfrom https://www.nejm.org/doi/full/10.1056/NEJMoa0810245 Herrington, G., Zardins, Y., & Hamilton, A. (2013). A pilot trial of emergency telemedicine in regional Western Australia.Journal of telemedicine and telecare,19(7), 430-433. doi: 10
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10.1177/1357633X13506531.Retrievedfrom https://journals.sagepub.com/doi/abs/10.1177/1357633X13506531 Klocko, D. J. (2009). Have the latest CPR guidelines improved cardiac arrest outcomes?.Journal oftheAmericanAcademyofPAs,22(11),30-35.Retrievedfrom http://www.sld.cu/galerias/pdf/sitios/anestesiologia/latest_cpr_guide_improved.pdf Mader, M. D. (2009). Hospital variation in time to defibrillation after in-hospital cardiac arrest. Retrieved fromhttps://scholarlycommons.libraryinfo.bhs.org/all_works/1236/ Nehme, Z., Bernard, S., Cameron, P., Bray, J. E., Meredith, I. T., Lijovic, M., & Smith, K. (2015). Using a cardiac arrest registry to measure the quality of emergency medical servicecare:decadeoffindingsfromtheVictorianAmbulanceCardiacArrest Registry.Circulation:CardiovascularQualityandOutcomes,8(1),56-66.doi: 10.1161/CIRCOUTCOMES.114.001185.Retrievedfrom https://www.ahajournals.org/doi/abs/10.1161/circoutcomes.114.001185 Ramelet, A. S., Gill, F., & Group, I. (2012). A Delphi study on National PICU nursing research priorities in Australia and New Zealand.Australian Critical Care,25(1), 41-57. doi: 10.1016/j.aucc.2011.08.003.Retrievedfrom https://www.sciencedirect.com/science/article/abs/pii/S103673141100138X 11