E-learning: Improving Multidisciplinary Paediatric CPR

The Children’s Hospital at Westmead

Abstract

Annual CPR accreditation was mandatory for all nurses at The Children’s Hospital at Westmead (CHW), however formal training for medical staff was minimal.

An e-learning resuscitation module was developed and then evaluated using a before and after study on Emergency Department doctors and new graduate nurses. Participants completed a mock clinical scenario and were scored on their ability to perform basic and advanced life support. They then completed the e-learning program and were retested.

There was an improvement in participants’ ability to perform basic life support by 51 % (p<0.001), advanced life support by 57 % (p<0.001), time to rhythm recognition by 19% (p=0.006) and to first defibrillation by 24% (p=0.009). When comparing participants’ pre and post test multiple choice question scores, there was a mean increase in knowledge of 24 %.

 Download the presentation given at the 2008 NSW Health Expo (731 KB).

Aim

To introduce and validate a novel approach to multidisciplinary cardiopulmonary resuscitation (CPR) training, to be available by January 2008 and to obtain at least a 90 % compliance rate.

Nature of the Problem

At the time of starting this project, annual CPR accreditation was mandatory for all nurses at CHW. This was supported by a ward-based education program. However, formal training or assessment for medical staff was minimal.

The provision of appropriate and ongoing CPR training is a policy directive of NSW Health and the ability to perform CPR is a component of the training required for many disciplines, including the Royal Australasian College of Physicians, the Australasian College of Emergency Physicians and the Royal Australasian College of General Practitioners. In addition, the provision of resuscitation training is supported by the EQuIP 4 hospital accreditation process by the Australian Council on Healthcare Standards.

Extent of the Problem

Junior medical staff, through their representation on the Medical Education Committee and Resident Training Sub-committee, had expressed their need and desire for more teaching and practice in CPR.

Strategic Hospital committees, such as the Resuscitation Committee, also identified the gap in training and made the development of medical staff training a priority. This group also identified that the current nursing process of completing a written paper and then a practical session might be made more efficient.

Anecdotal and IIMS reports from incidents within the Hospital suggested that the knowledge and confidence in performing CPR could be improved.

The Team Leader was part of all of these groups and identified that there were barriers to CPR training, including lack of time for instructors, lack of time for participants, shift work rosters and limited availability of equipment. This suggested that an e-learning solution might be appropriate.

Strategic Importance

The project relates to the strategic directions of CHW and NSW Health to improve health for children and young people and provide better experiences in the health system.

By building the skills of the workforce, a higher quality service can be provided, resulting in improved experiences and outcomes for patients.

This project has the potential to positively impact targets from the NSW State Health Plan:

• to reduce the number of potentially avoidable deaths
• to invest in electronic information systems to support clinicians delivering improved clinical outcomes, making effective use of health resources

Planning and Implementing Solutions

The Team Leader took on the role of Project Manager, with input from other team members, the Education Centre, Audiovisual Services, Information Technology (IT) Services and subject matter experts.

A business plan was written and funding of approximately $33,000 obtained from a private donor and the Hospital, with the support of the Chief Executive.

The team used the new resuscitation guidelines, from the Australian Resuscitation Council, as well as other resources, such as Advanced Paediatric Life Support, to define the subject matter to be covered. They then contributed to the instructional design process, producing an instructional design map, storyboard and a video script. These elements of the instructional design process were reviewed several times by the team and subject matter experts. Any areas of controversy were settled by consensus opinion.

In order to be effective at CHW, the product had to amalgamate with our current e-learning system. Therefore the decision was made to program in Authorware and to produce outputs that could feed into the current learning management software, Pathlore. It was also important to produce video that could be streamed over the intranet easily and reliably.
The first version was piloted and reviewed in early 2007 and in July 2007 the final product was ready for formal evaluation.

A before and after study on Emergency Department doctors and new graduate nurses in July 2007 was used to evaluate the program. Participants completed a mock clinical scenario on a mannequin and were scored on their ability to perform Basic (BLS) and Advanced Life Support (ALS). They then completed the e-learning program and were retested approximately six weeks later using a similar scenario.

The program was then made available to all staff via the intranet, although Emergency Department doctors were targeted, requiring 90 % compliance from term one 2008.

Outcomes and Evaluation

56 clinicians were enrolled in the study (29 doctors and 27 nurses). 37 were retested (25 doctors and 12 nurses). The mean time between tests was 49 days. The resuscitation e-learning module improved participants’ ability to perform BLS by 51 % (p<0.001) and ALS by 57 % (p<0.001) – figure 1.

Figure 1. Competence at BLS and ALS before and after e-learning

There were also significant improvements in time to rhythm recognition of 19% (p=0.006) and time to first defibrillation of 24% (p=0.009) as well as significant increases in subjective knowledge and confidence – shown in figures two and three. In addition, 97 % of participants agreed or strongly agreed that the course had improved their knowledge and 92 % agreed or strongly agreed that the course had improved their confidence.

Figure 2. All participants - Knowledge

Figure 3. All participants - Confidence

This study validated the program, which is currently available on the e-learning portal Hospital-wide.

The program has been mandatory for all doctors in the Emergency Department since term one 2008 and has had over 95 % compliance. Reports are provided to each trainee’s supervisor each term.

Between January and May 2008, 326 staff logged on to the program and 169 completed it (93 nurses, 73 doctors and 3 other). When comparing participants pre test and post test multiple choice question score, participants showed a mean increase in knowledge of 24 %.

Sustaining Change

Having performed the validation study, it was easy to demonstrate to the Executive and to staff the need for this type of training.

Hospital-wide access via the intranet and the flexible delivery means that the module can be completed in parts when staff have a few spare minutes, either in their offices or clinical areas. 

The module has recently been adopted by the Hospital as part of the annual mandatory CPR training for all clinical staff, which will now be monitored regularly.

Future Scope

IT services are currently exploring options to have this module available to all NSW Health employees via the Clinical Information Access Project (CIAP) and the internet.

The author has applied for funding to convert the module for use by lay people, either within NSW Health or in the community.

There is a potential to develop adult and neonatal resuscitation modules in a similar e-learning format.

The ability to access modules from home is important as staff can then complete their education at their own pace in their home environment.

Contact

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