Congress Abstracts 2005

51

GETTING TO THE HEART OF CARDIOPULMONARY EMERGENCIES IN ONCOLOGY PATIENTS. Lorna P. Baker, MSN, ARNP, CCRN, OCN^®, H. Lee Moffitt Cancer Centre & Research Institute, Tampa, FL.

Oncology patients have a range of co-morbidities, and varied educational strategies are necessary to prepare nurses for cardiopulmonary emergencies.

Our 162 bed NCI-Comprehensive Cancer Centre has no emergency department, but cares for cancer patients with a range of co-morbidities. Ventricular fibrillation is the primary pathology in adult cardiac arrests, and the best chance for survival is early defibrillation. Recognizing this, the hospital replaced existing defibrillators with those equipped with built-in Automated External Defibrillators (AEDs). Institution-wide inservices were conducted. Still, codes are relatively infrequent, and the comfort level in first responders is low. Direct observation and review of Code Blue documentation revealed no AED use prior to arrival of the code team. Some nurses expressed the need to practice. The Critical Care Nurse Manager obtained approval from the Code Blue Committee for the author to conduct mock codes institution-wide. The purpose of this abstract is to discuss a process for increasing oncology nurses comfort with cardiopulmonary emergencies.

The Critical Care CNS and Center Educators conduct monthly mock codes, rotating between inpatient and outpatient settings. The first “code” met with resistance and we learned that a certain amount of preparation promotes a smoother process. The chief resident is now notified a few days prior to the “code”. She alerts the residents and encourages their participation. The unit’s clinical leader assigns a nurse to “the patient”. As code team members check in, they are given the opportunity to be excused or to participate in making the scenario more realistic. The code is stopped after successfully implementing ACLS protocols. One Educator completes a QI monitor, which is used to provide feedback to the staff.

Participant feedback has been positive, and we continue to receive requests for mock codes in other areas and other shifts. Identified deficiencies in knowledge and performance are corrected through continued education. The QI monitor will serve as the tool to measure effectiveness of this exercise.

By improving staff proficiency with use of the AED mode, we expect to see increased utilization and demonstration of competence in code situations. Optimally, we would expect improved patient outcomes in cardiopulmonary emergencies.