Ward Characteristics Related to Quality and Pitfalls of Basic Life Support in Cardiopulmonary Resuscitation Simulated Survey
Authors: Kattiya Manomayangkul, M.D., Arunotai Siriussawakul, M.D., Khemchat Wangtawesap, M.D., Onuma Chaiwat, M.D., Tipa Chakorn, M.D., Sudta Parakkamodom, RN, Panisara Saengsung, RN, Thanawin Chawaruechai, RN, Chulaluk Komoltri, Dr PH.
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Objective: To assess the quality of nurses’ basic life support (BLS) and to determine pitfalls in BLS in relation to ward characteristics.
Setting: A 2,400-bed university hospital in Thailand.
Methods: A 1-year retrospective simulated audit for 2009 to assess nurses’ BLS performance at each step. Each observer as- sessed the subjects’ performance by using a scoring sheet and noting the objective manikin data related to chest compression. Results: A total of 57 wards from intensive care units, critical wards, procedural units, general wards or outpatient units were audited. Only 24 out of 57 (42.1%) did airway maneuvers correctly, while only 2 out of 57 (3.5%) could rescue breathing with chest movement. For the circulation maneuvers, carotid pulse check, hand position, the depth and the rate of cardiac compression were mostly performed incorrectly. Exactly 14.0% of subjects did not palpate the carotid pulse, and 52.6% palpated it incorrectly. Thirty-three nurses (57.9%) located and placed their hands on the wrong position. Forty-one nurses (71.9%) did not achieve the requisite chest compression depth, while thirty-one nurses (54.4%) did not achieve the target chest compression rate. The overall BLS performance of nurses in the High Risk Zone was better than that of nurses in the Low Risk Zone, except in the case of the airway sector.
Conclusion: The CPR audit evaluated the resuscitation performance during simulated cardiac arrest in the service setting, and compared wards nurses in 2 categories related to the risk of cardiac arrest. Improvement in the organisation of training and the systematic approach to CPR should be adopted.