ASSESSMENT TOOL FOR A STANDARDIZED VENTRICULAR FIBRILLATION CARDIAC ARREST - PowerPoint PPT Presentation

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ASSESSMENT TOOL FOR A STANDARDIZED VENTRICULAR FIBRILLATION CARDIAC ARREST

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Title: ASSESSMENT TOOL FOR A STANDARDIZED VENTRICULAR FIBRILLATION CARDIAC ARREST


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(No Transcript)
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ASSESSMENT TOOL FOR A STANDARDIZED VENTRICULAR
FIBRILLATION CARDIAC ARREST
  • Jessie Weaver, Meds IV
  • Damon Dagnone, MD

3
Disclosure
? I do not have an affiliation (financial or
otherwise) with any commercial organization that
may have a direct or indirect connection to the
content of my presentation. ? I have/had an
affiliation (financial or otherwise) with a
commercial organization that may have a direct or
indirect connection to the content of my
presentation.
4
  • RESEARCH OBJECTIVE
  • We set out to derive and test the performance of
    a preliminary assessment tool for a standardized
    ventricular fibrillation cardiac arrest scenario

5
  • INTRODUCTION
  • Emergency Medicine training programs need
    competency-based assessment tools to evaluate how
    trainees perform in resuscitation
  • We used the ILCOR 2005 algorithm for ventricular
    fibrillation to help derive an assessment tool
    for our initial study

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  • INTRODUCTION
  • Standardized performance assessments of trainees
    during ED resuscitations is challenging and can
    compromise patient safety
  • Initial testing of the assessment tool was
    carried out in a high fidelity simulation-based
    environment at Queens University

7
  • METHODS
  • We developed a standardized ventricular
    fibrillation arrest scenario that required 2
    defibrillation attempts
  • The assessment tool was comprised of three
    separate checklists
  • Essential Actions, Time to Action, and Global
    Assessment
  • The checklists were derived by a panel of medical
    experts in resuscitation from within our
    institution

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  • METHODS
  • Our study group included 4th year medical
    students, 4th year nursing students, junior
    medical residents, and senior medical residents
    in Emergency Medicine
  • Each of the study groups (n 5 per group)
    performances were videotaped and reviewed by 3
    blinded medical experts
  • Correlation analyses and analyses of variance
    were applied to the assessment tools performance

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CRITICAL ACTIONS checklist NOT DONE (0)
DONE POORLY (1) DONE WELL (2) N
/ A PRIMARY ASSESSMENT LOC assessed AIRWAY/BREATHI
NG assessed BVM 2 breaths delivered PULSE
check Call for HELP / CODE BLUE INITIATION OF
TASKS BVM CPR 302 X 5 cycles MONITOR IV
ACCESS TEAM LEADER position COORDINATION OF
TASKS Initial RHYTHM IDENTIFICATION Initial
DECISION for DEFIBRILLATION First DEFIBRILLATORY
SHOCK Reassessment of RHYTHM Reassessment of
VITAL SIGNS with ROSC
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TIME TO ACTION checklist NOT DONE
DONE TIME (sec) Call for help / code blue /
crash cart Initial 2 breaths BVM with O2 Initial
PULSE check Initiation of CPR Initial RHYTHM
IDENTIFICATION Initial DECISION for
DEFIBRILLATION First DEFIBRILLATORY
SHOCK Reassessment of RHYTHM Reassessment of
VITAL SIGNS with ROSC
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  • GLOBAL ASSESSMENT checklist
  • 1 2 3 4 5
  • FAIL MARGINAL PASS GOOD EXCELLENT

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  • RESULTS
  • A total of 18 study groups were assessed in their
    performance of the VFIB arrest scenarios
  • They were categorized based on the educational
    level of the team leader
  • 4 senior residents
  • 7 junior residents
  • 7 medical/nursing students

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Table 1 Summary of Checklist Scores
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Table 2 Inter-rater agreement for Essential
Actions Global Assessment
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Table 3 Correlation scores for Essential Actions
and Global Assessment
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  • DISCUSSION
  • The simulated VFIB arrest scenario was easily
    reproducible with the high-fidelity medical
    simulator
  • Videotaping performances allowed for independent
    and standardized expert evaluation that
    facilitated the use of the assessment tool
    checklists

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  • DISCUSSION
  • The assessment tool was able to discriminate
    performance with respect to level of training
  • Essential Actions and Global Assessment but not
    Time to Action
  • Inter-rater reliability for Essential Actions and
    Global Assessment were strong
  • Scores for Essential Actions correlated well with
    Global Assessment

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  • LIMITATIONS
  • The assessment tool has only been piloted in a
    small sample population of trainees
  • Checklist scoring items were equally weighted
    regardless of necessity of action or therapeutic
    benefit
  • Expert examiners were not blinded to the training
    level of all study subjects

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  • CONCLUSIONS
  • This pilot study demonstrates a valid
    simulation-based assessment tool for a
    standardized ventricular fibrillation cardiac
    arrest scenario
  • The study shows great promise for the development
    and implementation of additional simulation-based
    assessment tools

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  • ACKNOWLEDGEMENTS

Dr. Damon Dagnone (Supervisor) dagnoned_at_kgh.kari.n
et Dr. Bob McGraw Cheryl Pulling, RN Marian
Luctkar-Flude, RN Will Pickett, PhD
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QUESTIONS ?
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