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Use of checklists facilitates guideline adherence in prehospital emergency care
Abstracts / Resuscitation 85S (2014) S15–S121
practical workshops on fundamental aspects on quality CPR that teachers were expected to confidently convey to the school community. Instructor–professor ratios were 1: 4–6. Peer assessments were carried out to ensure learning objectives were accomplished. In the third phase teachers carried out a school project, after which evaluation of the process and problems they encountered and consequent iterations to the course were made. Diverse didactic material (powerpoints, dvds, posters, stickers) was provided along with 145 manikins on a free rental basis throughout the academic year. Teachers informed on successive training through an online questionnaire. The association offered continued support whenever needed. Results: Between 2011 and 2013, 190 teachers were trained in 7 courses. Teachers reported training of 10,835 people in their school communities, the majority students, the rest included other teachers and personnel, and parents. 76% of the teachers actually continued offering CPR training in their schools one year after. Conclusions: When appropriate training and materials are made available, teachers are willing to learn and spread CPR in their school communities on a long term basis. Further reading 1. Soar J, Koenraad GM, Ballance JH, et al. European resuscitation council guidelines for resuscitation 2010 section 9: principles of education in resuscitation. Resuscitaion 2009;81:1434–44. 2. Plant N, Taylor K. How best to teach CPR to school children: a systematic review. Resuscitation 2013;84:415–21.
http://dx.doi.org/10.1016/j.resuscitation.2014.03.163 AP115 The ‘Learning conversation’ as a style of feedback in resuscitation courses Elizabeth M. Norris ∗ , Ian Bullock Educator Resuscitation Council UK, London, UK This paper explores the history behind the introduction and use of the learning conversation as a mechanism of providing effective feedback to candidates on resuscitation courses. The central aim of the learning conversation is to promote and support greater self-awareness of the individual student in order to develop competence and team leadership through critical inquiry.1 Learning, particularly in the context of resuscitation is demonstrated by the utilisation of “planned experience which brings about a change of behaviour,2 and the process is facilitated by feedback whether during skills teaching, in workshops or in simulation. The learning conversation is an empathic, respectful listening and advising conversation between a group of adults, facilitated to ensure that key learning emerges from this process that informs future practice and behaviours. A mnemonic has been developed to facilitate acquisition of the skills involved. Faculty development will be needed to continue to develop the full implementation of the learning conversation as a feedback tool on resuscitation courses, animating the principles of adult learning.
AP116 Use of checklists facilitates guideline adherence in prehospital emergency care Hartwig Marung 1,∗ , Willi Schmidbauer 2 , Mares Tietz 3 , Harald Genzwuerker 4 , Thoralf Kerner 5 1
Institute of Emergency Medicine, Hamburg, Germany 2 Department of Anesthesiology, Intensive Care and Emergency Medicine, Armed Forces Hospital, Hamburg, Germany 3 Department of Anesthesiology, Intensive Care and Emergency Medicine, Armed Forces Hospital, Berlin, Germany 4 Department of Anaesthesiology and Intensive Care Medicine Neckar Odenwald Hospitals, Mosbach, Germany 5 Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain Management, Asklepios Hospital Harburg, Hamburg, Germany Background: High quality emergency medical care requires transfer of evidence based knowledge into practice. The implementation of Standard Operating Procedures (SOP) alone is not sufficient to ensure adherence to guidelines.1 Checklists have proven to reduce perioperative mortality significantly.2 Our study investigated the usability of checklists in order to improve quality and safety in prehospital emergency care. Methods: Three checklists based upon SOP were introduced: General principles of prehospital care, Acute Coronary Syndrome (ACS), Acutely exacerbated Chronic Obstructive Pulmonary Disease (COPD). Immediately before transport medical history, diagnostic and therapeutic procedures were retrieved. Data of 740 respective emergency missions were recorded prospectively before and after implementation of checklists und compared by chi square test (significance level p < 0.05). Results: Records concerning patients’ history [pre-existing diseases 69.1 vs. 74.1%; medication: 55.8 vs. 68.0%; allergies: 6.2 vs. 27.7%], diagnostic measures [oxygen saturation: 93.2 vs. 98.1%; auscultation: 11.1 vs. 19.9%] and basic procedures [application of oxygen: 73.2 vs. 85.3%; iv-access: 84.6 vs. 92.2%] improved significantly. Subanalysis of ACS cases revealed significant increase of 12 lead ECG use [74.3 vs. 92.4%], administration of oxygen [84.2 vs. 98.6%], ASA [71.7 vs. 81.9%), heparine [71.1 vs. 84.0%], beta blockers [35.5 vs. 53.3%] and morphine [26.8 vs. 44.6%]. In the COPD subgroup oxygen supply [78.8 vs. 98.5%] and intravenous application of ß2 -mimetics [71.7 vs. 81.9%] increased significantly. Conclusions: Introduction of checklists into prehospital emergency care may help to improve adherence to current guidelines. Additional efforts such as repetitive team trainings must be made in order to further raise quality and safety of care. References 1. Bosse G, Schmidbauer W, Spies C, et al. J Int Med Res 2011;39:267–76. 2. Haynes AB, Weiser TG, Berry WR, et al. N Engl J Med 2009;360:491–9.
References http://dx.doi.org/10.1016/j.resuscitation.2014.03.165 1. Harri-Augstein S, Thomas L. Learning Conversations. New York: Routledge; 1991. 2. Bullock I, Davis M, Lockey A, Mackway-Jones K. Pocket guide to Teaching for Medical instructors. 2nd ed. ALSG, Resuscitation Council UK; 2008.
http://dx.doi.org/10.1016/j.resuscitation.2014.03.164
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practical workshops on fundamental aspects on quality CPR that teachers were expected to confidently convey to the school community. Instructor–professor ratios were 1: 4–6. Peer assessments were carried out to ensure learning objectives were accomplished. In the third phase teachers carried out a school project, after which evaluation of the process and problems they encountered and consequent iterations to the course were made. Diverse didactic material (powerpoints, dvds, posters, stickers) was provided along with 145 manikins on a free rental basis throughout the academic year. Teachers informed on successive training through an online questionnaire. The association offered continued support whenever needed. Results: Between 2011 and 2013, 190 teachers were trained in 7 courses. Teachers reported training of 10,835 people in their school communities, the majority students, the rest included other teachers and personnel, and parents. 76% of the teachers actually continued offering CPR training in their schools one year after. Conclusions: When appropriate training and materials are made available, teachers are willing to learn and spread CPR in their school communities on a long term basis. Further reading 1. Soar J, Koenraad GM, Ballance JH, et al. European resuscitation council guidelines for resuscitation 2010 section 9: principles of education in resuscitation. Resuscitaion 2009;81:1434–44. 2. Plant N, Taylor K. How best to teach CPR to school children: a systematic review. Resuscitation 2013;84:415–21.
http://dx.doi.org/10.1016/j.resuscitation.2014.03.163 AP115 The ‘Learning conversation’ as a style of feedback in resuscitation courses Elizabeth M. Norris ∗ , Ian Bullock Educator Resuscitation Council UK, London, UK This paper explores the history behind the introduction and use of the learning conversation as a mechanism of providing effective feedback to candidates on resuscitation courses. The central aim of the learning conversation is to promote and support greater self-awareness of the individual student in order to develop competence and team leadership through critical inquiry.1 Learning, particularly in the context of resuscitation is demonstrated by the utilisation of “planned experience which brings about a change of behaviour,2 and the process is facilitated by feedback whether during skills teaching, in workshops or in simulation. The learning conversation is an empathic, respectful listening and advising conversation between a group of adults, facilitated to ensure that key learning emerges from this process that informs future practice and behaviours. A mnemonic has been developed to facilitate acquisition of the skills involved. Faculty development will be needed to continue to develop the full implementation of the learning conversation as a feedback tool on resuscitation courses, animating the principles of adult learning.
AP116 Use of checklists facilitates guideline adherence in prehospital emergency care Hartwig Marung 1,∗ , Willi Schmidbauer 2 , Mares Tietz 3 , Harald Genzwuerker 4 , Thoralf Kerner 5 1
Institute of Emergency Medicine, Hamburg, Germany 2 Department of Anesthesiology, Intensive Care and Emergency Medicine, Armed Forces Hospital, Hamburg, Germany 3 Department of Anesthesiology, Intensive Care and Emergency Medicine, Armed Forces Hospital, Berlin, Germany 4 Department of Anaesthesiology and Intensive Care Medicine Neckar Odenwald Hospitals, Mosbach, Germany 5 Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain Management, Asklepios Hospital Harburg, Hamburg, Germany Background: High quality emergency medical care requires transfer of evidence based knowledge into practice. The implementation of Standard Operating Procedures (SOP) alone is not sufficient to ensure adherence to guidelines.1 Checklists have proven to reduce perioperative mortality significantly.2 Our study investigated the usability of checklists in order to improve quality and safety in prehospital emergency care. Methods: Three checklists based upon SOP were introduced: General principles of prehospital care, Acute Coronary Syndrome (ACS), Acutely exacerbated Chronic Obstructive Pulmonary Disease (COPD). Immediately before transport medical history, diagnostic and therapeutic procedures were retrieved. Data of 740 respective emergency missions were recorded prospectively before and after implementation of checklists und compared by chi square test (significance level p < 0.05). Results: Records concerning patients’ history [pre-existing diseases 69.1 vs. 74.1%; medication: 55.8 vs. 68.0%; allergies: 6.2 vs. 27.7%], diagnostic measures [oxygen saturation: 93.2 vs. 98.1%; auscultation: 11.1 vs. 19.9%] and basic procedures [application of oxygen: 73.2 vs. 85.3%; iv-access: 84.6 vs. 92.2%] improved significantly. Subanalysis of ACS cases revealed significant increase of 12 lead ECG use [74.3 vs. 92.4%], administration of oxygen [84.2 vs. 98.6%], ASA [71.7 vs. 81.9%), heparine [71.1 vs. 84.0%], beta blockers [35.5 vs. 53.3%] and morphine [26.8 vs. 44.6%]. In the COPD subgroup oxygen supply [78.8 vs. 98.5%] and intravenous application of ß2 -mimetics [71.7 vs. 81.9%] increased significantly. Conclusions: Introduction of checklists into prehospital emergency care may help to improve adherence to current guidelines. Additional efforts such as repetitive team trainings must be made in order to further raise quality and safety of care. References 1. Bosse G, Schmidbauer W, Spies C, et al. J Int Med Res 2011;39:267–76. 2. Haynes AB, Weiser TG, Berry WR, et al. N Engl J Med 2009;360:491–9.
References http://dx.doi.org/10.1016/j.resuscitation.2014.03.165 1. Harri-Augstein S, Thomas L. Learning Conversations. New York: Routledge; 1991. 2. Bullock I, Davis M, Lockey A, Mackway-Jones K. Pocket guide to Teaching for Medical instructors. 2nd ed. ALSG, Resuscitation Council UK; 2008.
http://dx.doi.org/10.1016/j.resuscitation.2014.03.164
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