Title: ASSESSMENT TOOL FOR A STANDARDIZED VENTRICULAR FIBRILLATION CARDIAC ARREST
1(No Transcript)
2ASSESSMENT TOOL FOR A STANDARDIZED VENTRICULAR
FIBRILLATION CARDIAC ARREST
- Jessie Weaver, Meds IV
- Damon Dagnone, MD
3Disclosure
? 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
6- 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
8- 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
9 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
10 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
11- GLOBAL ASSESSMENT checklist
- 1 2 3 4 5
- FAIL MARGINAL PASS GOOD EXCELLENT
12- 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
13Table 1 Summary of Checklist Scores
14Table 2 Inter-rater agreement for Essential
Actions Global Assessment
15Table 3 Correlation scores for Essential Actions
and Global Assessment
16- 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
17- 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
18- 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
19- 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
20Dr. Damon Dagnone (Supervisor) dagnoned_at_kgh.kari.n
et Dr. Bob McGraw Cheryl Pulling, RN Marian
Luctkar-Flude, RN Will Pickett, PhD
21QUESTIONS ?
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