Training and educational paperEvaluation of staff's retention of ACLS and BLS skills☆
Introduction
Annually, 350,000 cardiac arrests occur in the United States. When applied correctly, advanced cardiac life support (ACLS) and basic life support (BLS) restores circulation in 40–60% of cases1; provides oxygenation and restores spontaneous circulation and brain function.2 Nurses must be proficient in ACLS and BLS to respond. This study assessed hospital-employed RNs’ abilities over time to provide ACLS or BLS to American Heart Association (AHA) standards in a simulated environment.
Goals of BLS training are for staff to respond correctly to cardiac arrest, respiratory arrest, and foreign-body airway obstruction. Classes include tests of knowledge and psychomotor skills. ACLS builds upon BLS knowledge and skills.
ACLS organizes in-hospital treatment of cardiac arrest using life-saving algorithms.3 Poor performance of resuscitation may result in poor outcomes, such as patients who remain in vegetative states.
Healthcare professionals require skills and knowledge for successful resuscitation.4 Most hospitals require personnel to be certified in BLS every 2 years. RNs working in intensive care units and emergency departments may need ACLS certification.
Studies of healthcare and lay rescuers show that resuscitation skills degrade quickly and knowledge is retained longer than skills.5, 6, 7 Variables affecting skills retention are many and difficult to isolate. Factors that negatively affect retention are (1) insufficient hands-on practice, (2) inconsistent teaching, (3) unrelated course content, (4) complex instruction, (5) delays between instruction and skills practice, (6) lack of supervision, (7) low instructor feedback, and (8) instructor incompetence. Factors that positively affect skills retention include: (1) hands-on practice, (2) instruction simplicity, (3) multi-media presentations, and (4) feedback from instructors.5, 6, 7
Most research was completed before the International Liaison Committee on Resuscitation (ILCOR) 2000 changes in ACLS and BLS. Studies of RNs show similar findings on retention of skills. Problems with past studies are small convenience samples, lack of inter-rater reliability, and no comparison groups.
Section snippets
Materials and methods
This study sought to find the point at which RN skills and/or knowledge of ACLS and/or BLS degrade such that they do not meet AHA standards. Results may be used to design refresher training to bring skills back to standard.
Results
Demographic data for the groups are shown in Table 1, Table 2.
Discussion
Findings in this study are consistent with previous literature and demonstrate short retention times of skills in both BLS and ACLS (10, 11, and 16). The initial failure of BLS resuscitative skills (71.2%) was interesting considering that 50% of participants reported taking a BLS course within 1–3 months prior to testing.
Skills degradation was expected to occur in a linear fashion over time for both groups. The linear degradation would be present if the 9-month group performed as expected. The
Conclusions
This study identifies a significant problem: RNs in clinical settings may not perform life-saving ACLS and BLS skills to AHA standards. Retention of both basic and advanced resuscitation skills is short. ACLS and BLS skills retention needs to improve to reduce the potential risk of death and disability secondary to delay in resuscitation. Recommendations to improve RN skills retention from this research study are
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More frequent refresher training.
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Allow more time for hands-on skills practice.
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Conflict of interest
None.
Acknowledgements
This research was sponsored by the TriService Nursing Research Program, Uniformed Services University of the Health Sciences; however, the information or content and conclusions do not necessarily represent the official position or policy of, nor should any official endorsement be inferred by, the TriService Nursing Research Program, Uniformed Services University of the Health Sciences, the Department of Defense, or the U.S. Government.
References (15)
- et al.
Cardiopulmonary resuscitation: historical perspective to recent investigations
Am Heart J
(1999) - et al.
Cardiopulmonary resuscitation skills in nurses and nursing students
Resuscitation
(2000) - et al.
Perceived competence in cardiopulmonary resuscitation, knowledge, and skills amongst 50 qualified nurses
Intens Crit Care Nurs
(1992) - et al.
A revised role for the hospital cardiac arrest team?
Resuscitation
(1998) - et al.
Outcome after cardiac arrest in adults in UK hospitals: effect of the 1997 guidelines
Resuscitation
(2000) Advanced cardiac life support
(1997)- et al.
Advanced cardiac life support refresher course using standardized objective-based mega code testing
Crit Care Med
(1987)
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A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2008.02.007.