Enhancing hospital resuscitation in Convalescent and Rehabilitation Hospitals

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Abstract Summary
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Authors (including presenting author) :
Man JFK(1), Tang MWS(2), WAN PY(3), Woo LLC(2), Chui TWS(4), Lam HB(5), Poon MCY(6), Ng TH(7), Wong EWY(8), Mak KYM(9), Tsang CWY(10), Lee SY(1)
Affiliation :
(1) Quality & Safety Division, Bradbury Hospice, Shatin Cheshire Home & Shatin Hospital, (2)Medicine & Geriatric Department, Shatin Hospital, (3) Central Nursing Division, Bradbury Hospice & Shatin Hospital, (4) Palliative Care Unit, Shatin Hospital, (5) Psychiatry Department, Shatin Hospital, (6)Surgery Department, Shatin Hospital, (7) Occupational Therapy Department, Shatin Hospital, (8) Physiotherapy Department, Shatin Hospital, (9) Central Nursing Division, Shatin Cheshire Home, (10) Administration Department, Shatin Cheshire Home
Introduction :
Timely and effective cardiopulmonary resuscitation (CPR) with well-equipped resuscitation equipment saves patient’s/ victim’s life and enhances subsequent functional outcome. In 2017, Resuscitation Subcommittee was established in BBH, SCH and SH to improve hospital resuscitation service. The existing practices on resuscitation and first aids were reviewed. Also, improvement initiatives were implemented including upgrading of equipment; revision of guidelines and records as well as conducting staff training, audits and drills.
Objectives :
(1)To comply with hospital guidelines for resuscitation; (2) To enhance quality of cardiopulmonary resuscitation and first aids; (3) To provide adequate, appropriate and standardized resuscitation equipment in hospital premises; (4) To enhance staff’s knowledge and strengthen their skill on resuscitation
Methodology :
(1) Modern resuscitation trolleys were purchased and re-allocated in clinical areas. Instrument quantity, content and layout were aligned with photo labels posted for quick utilization. (2) Besides communal areas, an Automatic Emergency Defibrillator (AEDs) and resuscitation stretcher were installed at gymnasium for easy access by allied health professionals. (3) To facilitate designated response team (DRT) in responding to request for medical assistance in the vicinity of hospitals, handy first aids bag was introduced with unified content and layout of equipment. (4) The use of disposable resuscitators and laryngoscopes were introduced to save times in disinfection and reduced risk of cross infection. (5) Resuscitation manual and response plan were reviewed and revised including communication flow, staff deployment and etc. (6) CPR record was standardized to facilitate clinical documentation. (7) Two models of manikins were provided to facilitate skill training for staff. (8) External CPR drill was rescheduled and hospital based emergency medical assistance (EMA) drill was conducted to increase staff’s participation.
Result & Outcome :
A 11 total of modern resuscitation trolleys covering 25 clinical units and 4 first aids bags for 3 hospitals have been aligned in outlook and essential contents. A standardized checklist was utilized. Also, a surprise audit on resuscitation trolleys and first aid bags via clinical visit with equipment screening will be implemented in 1Q 2019 to monitor sustainability of the change. Since standardization of CPR record, 100% compliance rate was achieved in quarterly record audit in 2017 and 2018. The competence of staff in performing resuscitation and clinical documentation was improved. Also, staff satisfactory survey will be conducted in Q1 2019 to collect feedback for improvement. In BBH, SCH and SH, total 3 and 4 external CPR drills were conducted in 2017 and 2018 respectively. Accumulative 143 participants who were 8 medical, 110 nursing, 11 allied health professionals, 13 supporting staff and 147 observers joined the drills. In 2018, EMA drill in multidisciplinary approach was conducted with 85 participants, including 1 doctor, 25 nurses, 43 allied health professionals, 2 hospital administrators, 14 supporting staff and 77 observers. The overall performance was assessed by qualified external auditors with satisfactory result. Majority of the staff could demonstrate competent resuscitation skills and techniques. Designated role of CPR was performed. Organized team work and effective communication were achieved.

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