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Developing an Implementation Plan

This essay includes strategies that will be used to educate EMS workers and nurses on the earlier administration of therapeutic hypothermia to patients post cardiac arrest. In this essay, the methods of carrying out the research will be outlined. In addition the strategies involved along with their outcomes will be looked into. For this study to be a success it is also important that there be a mandated written competency evaluation along with a return demonstration exercise upon completion of educational service. Most often, the physician is the one referred to in the case of a post cardiac arrest orders. Consequently, late initiation or no initiation of therapeutic hypothermia result in patients who encounter cardiac arrest fail to recover and/or neural improvement or preservation is also curbed. EMS as well as Nurses requires education to provide immediate post cardiac intervention with therapeutic hypothermia. Current studies and evidence-based practice compiled by different authors show that with early initiation by educated EMS workers and Nurses in the emergency department, the post cardiac arrest patient has a higher chance of survival with neuronal preservation, therefore, cementing the need for educated EMS workers and nurses on the benefits of initiating therapeutic hypothermia to the post cardiac arrest patient as early as possible.

Presenting statistical, evidence-based research or data-analysis to the stakeholders will help to gain approval and/or support. There is strong evidence that supports Therapeutic Hypothermia (TH) to the unconscious post cardiac arrest patient; however, this procedure is underutilized prior to the patient being admitted to the Intensive Care Unit (ICU). One major reason for the underutilization of Therapeutic Hypothermia (TH) is the lack of Emergency Medical Service (EMS) and Nurses who can adequately initiate the therapeutic Hypothermia protocols. Educating EMS workers and Nurses in TH is not only a suggestion it is a necessity (Hardy-Joel, R. 2010) and an undeniable increase in the survival rate of post cardiac arrest patients along with an increase in neuronal preservation will be evident. According to Chiota, N., MD, Freeman, W., MD, Barrett, K., MD, MSc 2011, early initiation of therapeutic hypothermia post cardiac arrest, 80% showed good outcome compared to the twenty percent that had a poor outcome. These results were taken from a study conducted at a Mayo Clinic in Florida over a three year period and the information was taken from electronic medical records (EMR) at the time of discharge. Statistical information obtained during another study that compared literature gathered from a comprehensive database, showed that the implementation of policies that mandated, unconscious, out of hospital post cardiac arrest patients have early initiation of therapeutic hypothermia (Collins, T. J. 2008). Also gathered from this study was that there is a definite improvement to both morbidity and mortality (Collins, T. J. 2008). EMS workers and nurses are to follow a set of protocols initiated by the facilities that employ them. When this is not practiced, there is no way other than following a set of instructions for EMS or nurses to adequately ascertain whether the interventions are correctly applied or not or if inclusion criteria has been met. Lee, R. & Asare, K. (2010), said that “despite the growing number of publications in support of therapeutic hypothermia, this practice is still considered to be questionable and it is apparent that there is a definite lack of education, training and overall lack of set standards”. Many physicians still have not readily accepted this form of procedure for post cardiac arrest patients and will not initiate Therapeutic Hypothermia. With these few articles it is evident that there is a need for educating EMS workers and nurses in the area of Therapeutic Hypothermia post cardiac arrest.

Education first would consist of a speaker with experience in Therapeutic Hypothermia. This speaker would be an employee of the hospital that would be paid his/her regular salary for doing the in-service education. The speaker would 1. Define Therapeutic Hypothermia, 2. Explain inclusion and exclusion criteria, including any adverse reactions and how to treat them, according to the hospital policy, 3. Demonstrate a case scenario with group participation, 4. Answer any questions, 5. Help with making up mandated written exam and case scenario competency demonstration done by EMS workers and nurses, 6. Teach staff how to use the necessary equipment (NAEMSP Board of Directors, 2008), 7. Help with the continued competency requirements mandated by the hospital and EMS service employers.

For the implementation process the written exam and first case scenario would be given at the end of the in-service. The initial in-service would take a half day. EMS workers would be paid by their employers to attend the in-service at no additional charge from the hospital. Hospital emergency room and ICU nursing staff would be required to punch in and out as they would if they were coming to work. Additional in-services would be mandated and added to the continued competency required by the hospital to be performed on a yearly basis. Any staff hired after the class will be given their initial class and will be required to take the class again with the rest of the staff. Surveys and/or questionnaires would be provided to EMS workers and nurses to rate the education provided to them. The input from them is important in measuring the needed education and the measurement of education received. The input from the workers will also say whether or not this form of education is beneficial or if a revision is needed. Surveys and/or questionnaires would be useful in the assessment of the speaker(s) presentation and case scenario demonstration. A pre and post test would have to be given to assess the knowledge of the participants at baseline and to assess the education learned. The reasons for this particular implementation plan include the fact that it is standard practice that patients will be going to the ICU following a cardiac arrest resulting in unconsciousness. Patients who get to hospital lack the right methods of treatment before going to the ICU (NAEMSP Board of Directors, 2008). Mostly in part this is due to the lack of applicable education of EMS Workers and emergency room nurses. Hence, it is vital to note the vital principles and procedures involved in hypothermia administration before the patient gets into the ICU (Nielsen, N., Hovdenes, F., Rubertsson, S., Stammet, P., Sunde, K., Valsson, F., Wanscher, M., & Friberg, H.  2009).

Another area of education required is the patient to nurse ratio for the patient who has had Therapeutic Hypothermia initiated. Nurses should be well distributed in this unit. This is because it is crucial to check on the nurse to patient ratio at different times during the procedure. According to Olson, D, et al. (2009), it takes multiple interventions or tasks to manage and maintain the patient who had therapeutic hypothermia initiated. This therapy requires constant time consuming monitoring and interventions; interventions that take the nurse away from his/her other patients and duties. Within the first 6 hours, the respective ration should be 2:1. However, in the remaining part of the procedure, the ratio would be at 1:1. The reason for this besides the severity of the patient’s condition is it is helpful in ensuring that the problems are identified and the solutions are found within a reasonable timeframe.

In conclusion, EMS workers and nurses require education and skill on the proper way to initiate Therapeutic Hypothermia to their patients prior to reaching the hospital or going to the ICU. This education could be the difference in the statistically large numbers of cardiac arrest patients that result in death or a decrease in the number of cardiac arrest survivors that experience neuronal depletion. As such, the right implementation procedures should be put in place to ensure that a larger number of patients survive cardiac arrest. This research study and education would go a long way in reinforcing the nurses with the basic knowledge concerning how to handle a post cardiac arrest orders. It would also benefit the EMS workers and nurses if clinicians would consider revising their practice guideline and embrace new research and evidence-based practices and help to educate staff providing Therapeutic Hypothermia. Finally if the physicians would look at the data that benefits the patient if the patients temperature reaches 32-34 degrees Celsius within sixty minutes of initiating TH (Koran, Z. 2009), the morbidity and mortality rates would be reduced immensely if the procedures are followed accordingly. Koran, 2009 also states that “emergency departments have an obligation to their patients to not only initiate this procedure but also collaborate with critical care to continue the TH protocol”. This implementation would give rise to standard procedures and education to EMS workers and the hospital personnel. This would not only benefit EMS workers but would also benefit the emergency room nurses, help the ICU nurse stay competent while ensuring that the patient would have the most up to date, evidence- based practice care available.

 

Reference

Chiota, N., MD, Freeman, W., MD, Barrett, K., MD, MSc (2011). Earlier Hypothermia

Attainment is Associated with Improved Outcomes after Cardiac Arrest. J Vasc Interv

     Neurol. 2011 January; 4(1): 14–17. PMCID: PMC3317278

Collins, T. J. (2008).  “Therapeutic hypothermia following cardiac arrest: a review of the

evidence.” British Association of Critical Care Nurses, 13 (3), 144-151. Hardy-Joel, R.

(2010)”Therapeutic hypothermia.” Dynamics of Critical Care: 20-21.

Koran, Z. (2009). Therapeutic hypothermia in the postresuscitation patient: the development and

implementation of an evidence-based protocol for the emergency department… Reprinted

with permission from Advanced Emergency Nursing Journal, 2008;30(4):319-330. Copyright

©2008 Wolters Kluwer Health Lippincott Williams & Wilkin. Journal Of Trauma Nursing,

16(1), 48-57. doi:10.1097/01.JTN.0000348070.09712.40

Lee, R. & Asare, K. (2010).  “Therapeutic hypothermia for out-of-hospital cardiac arrest.” AMJ

Health-Syst Pharm 67, 1229-1237.

NAEMSP Board of Directors, (2008). “Induced Therapeutic Hypothermia in Resuscitated

Cardiac Arrest Patients.” Prehospital Emergency Care 12 (2008): 393-394. doi:

10.1080/10903120802097173.

Olson, D, et al. (2009).  “Critical care nurses’ workload estimates for managing patients during

Induced hypothermia.” Nursing in Critical Care 13 (6), 305-309.

 

 

 

 

 

 

 

 

 

 

 

 

 

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