Identifying and Overcoming Barriers to CPR Education in Family Members and Caregivers of at Risk Patients Judy Vierke, RN, MS, CCNS Manager of Education & Prevention Edward Heart Hospital David Hiltz, NREMT-P American Heart Association

Conflict of Interest Disclosure Vierke Commercial/industry No Conflicts to disclose Potential intellectual conflicts No Conflicts to disclose

Commercial/industry

No Conflicts to disclose

Potential intellectual conflicts

No Conflicts to disclose

Conflict of Interest Disclosure Hiltz Commercial/industry Full-time employment by the American Heart Association Potential intellectual conflicts Full-time employment by the American Heart Association

Commercial/industry

Full-time employment by the American Heart Association

Potential intellectual conflicts

Full-time employment by the American Heart Association

Objectives Identify perceptions and barriers that impact family members of high-risk cardiac patients from learning cardiopulmonary resuscitation (CPR). Discuss how to implement a program that will assist physicians in recommending CPR training for high-risk family members. Describe innovative teaching modalities available for reaching community participants with different learning styles and need to increase the number of trained participants available within a community.

Identify perceptions and barriers that impact family members of high-risk cardiac patients from learning cardiopulmonary resuscitation (CPR).

Discuss how to implement a program that will assist physicians in recommending CPR training for high-risk family members.

Describe innovative teaching modalities available for reaching community participants with different learning styles and need to increase the number of trained participants available within a community.

Facts 335,000 Sudden Cardiac Arrests (SCA) 163,221 out-of-hospital SCA 80 % SCA occur in or near home Spouse or family members most likely to witness

335,000 Sudden Cardiac Arrests (SCA)

163,221 out-of-hospital SCA

80 % SCA occur in or near home

Spouse or family members most likely to witness

Literature Family members of high-risk populations: Benefit from learning CPR Learn CPR successfully without deleterious psychosocial consequences Not likely to seek CPR training Least likely to actually receive CPR training

Family members of high-risk populations:

Benefit from learning CPR

Learn CPR successfully without deleterious psychosocial consequences

Not likely to seek CPR training

Least likely to actually receive CPR training

Alternative methods must be developed to market CPR training to these groups!

Alternative methods

must be developed

to market CPR training

to these groups!

No CPR Information!

Hear no evil, see no evil, speak no evil!

Case For Support G2000 (IIa) Families and caregivers of: infants and children at risk adults at risk G2005

G2000 (IIa)

Families and caregivers of:

infants and children at risk

adults at risk

G2005

Charges! Additional studies are needed To confirm what type of courses lead to increased participation in CPR training Describe factors that prevent healthcare professionals from recommending CPR training to families of at-risk patients Identify CPR training methods that are most attractive to families and caregivers of at-risk patients

Additional studies are needed

To confirm what type of courses lead to increased participation in CPR training

Describe factors that prevent healthcare professionals from recommending CPR training to families of at-risk patients

Identify CPR training methods that are most attractive to families and caregivers of at-risk patients

Edward Heart Hospital

Institutional Culture Progressive Heart Hospital Focus on Patient, Family and Staff Education & Prevention Alliance with American Heart Association (AHA) AHA Training Center Presence in Community for Cardiac Education & Prevention, CPR & AEDs Resistance to discussing CPR with families

Progressive Heart Hospital

Focus on Patient, Family and Staff Education & Prevention

Alliance with American Heart Association (AHA)

AHA Training Center

Presence in Community for Cardiac Education & Prevention, CPR & AEDs

Resistance to discussing CPR with families

Research Questionnaire Institutional Review Board (IRB) Patient Survey Family Member Survey Physician / Advanced Practice Nurse (APN) Survey

Institutional Review Board (IRB)

Patient Survey

Family Member Survey

Physician / Advanced Practice Nurse (APN) Survey

Patient Surveys Distributed through Cardiac Rehab 31 surveys returned Mean age 65 68 % male 81 % lived with family / friends

Distributed through Cardiac Rehab

31 surveys returned

Mean age 65

68 % male

81 % lived with family / friends

Patient Survey 94 % think that knowing CPR is important for family members of people with heart disease 97 % would encourage their family members to learn CPR

94 % think that knowing CPR is important for family members of people with heart disease

97 % would encourage their family members to learn CPR

Patient Survey 53 % would have liked a healthcare professional to have discussed options of CPR with their family Only 30 % of the time did a healthcare professional discuss / recommend CPR training with family

53 % would have liked a healthcare professional to have discussed options of CPR with their family

Only 30 % of the time did a healthcare professional discuss / recommend CPR training with family

Patients want us to discuss CPR more with their families!

Family Survey 24 surveys returned 7 patients lived alone Mean age 59 73 % would have liked a healthcare professional to discuss CPR options Only 21 % stated a healthcare professional discussed CPR

24 surveys returned

7 patients lived alone

Mean age 59

73 % would have liked a healthcare professional to discuss CPR options

Only 21 % stated a healthcare professional discussed CPR

Family Survey 95 % think CPR is important for family members of people with heart disease 86 % felt they are able to acquire knowledge and physically capable of learning CPR

95 % think CPR is important for family members of people with heart disease

86 % felt they are able to acquire knowledge and physically capable of learning CPR

Family Survey 50 % had prior training in CPR 82 % greater than 2 yrs ago 91 % had no training in AEDs Only 24 % felt “somewhat confident” in their CPR skills 76 % “unconfident” in skills

50 % had prior training in CPR

82 % greater than 2 yrs ago

91 % had no training in AEDs

Only 24 % felt “somewhat confident” in their CPR skills

76 % “unconfident” in skills

Family Survey Reasons for not taking CPR 50 % never thought of it * 33 % not a priority * 8 % lack of information * 8 % anxiety * * Healthcare Professionals can assist in overcoming these barriers

Reasons for not taking CPR

50 % never thought of it *

33 % not a priority *

8 % lack of information *

8 % anxiety *

* Healthcare Professionals can assist in overcoming these barriers

Family Survey – Likely to Take CPR If … 87 % Info available 91 % Health professional / Physician recommend 100 % No written test

87 % Info available

91 % Health professional / Physician

recommend

100 % No written test

Family Survey What is the ideal class style / learning model? 50 / 50 split Traditional instructor class vs. home self study No statistical difference age or educational level

What is the ideal class style / learning model?

50 / 50 split

Traditional instructor class vs. home self study

No statistical difference

age or educational level

Families want us to discuss CPR with them Families are uncomfortable with their CPR skills We can impact number of families becoming trained Key Points:

Families want us to discuss CPR with them

Families are uncomfortable with their CPR skills

We can impact number of families becoming trained

Physician / Advance Practice Nurse (APN) Survey 26 Surveys Mean age 43 31 % Internal medicine 19 % Cardiology 15 % Family Practice 15 % APN 19 % Other

26 Surveys

Mean age 43

31 % Internal medicine

19 % Cardiology

15 % Family Practice

15 % APN

19 % Other

Physician / APN Survey 35 % both BLS & ACLS 23 % BLS 8 % ACLS 19 % have performed CPR out of the hospital setting

35 % both BLS & ACLS

23 % BLS

8 % ACLS

19 % have performed CPR out of the hospital setting

Physician / APN Survey Routinely Counsel on: 100 % Risk factor modification 81 % Warning signs of heart attack 73 % Importance of calling 911

Routinely Counsel on:

100 % Risk factor modification

81 % Warning signs of heart attack

73 % Importance of calling 911

Physician / APN Survey Reasons for not recommending CPR 54 % Lack of information on classes 50 % Never thought of it 27 % No time 12 % Concerns of anxiety No one felt it was inappropriate

Reasons for not recommending CPR

54 % Lack of information on classes

50 % Never thought of it

27 % No time

12 % Concerns of anxiety

No one felt it was inappropriate

100 % Physician / APN Supportive of CPR Script Name: ___________________________Date: __________ Education Prescription ___ Cardiac Rehab/Exercise Call 630-527-3388 ___ Diabetes Education Call 630-527-3213 ___ Heart Coach Call 630-527-2825 ___ Metabolic Syndrome / Weight Loss Program Call 630-527-2825 ___ Cardiovascular Screenings For Loved Ones Call 630-527-2825 ___ Ultrafast Heart Scan ___ Stroke & Vascular Screening ___ Cholesterol Screening ___ Stress Workshop ___ Delicious Meets Nutritious ___ Blood Pressure Workshop ___ Smoking Cessation ___ Cholesterol Workshop ___ CPR for Loved Ones Call 630-527-6363 for dates, fees, and registration. Signature: ______________________________, M.D./R.N. additional information on back

100 % Physician / APN Supportive of CPR Script

Next Steps Adding CPR to our education prescription Monitor enrollments to CPR classes from education prescription Re-survey physician / APN for changes in practice Investigate & implement CPR Anytime program with inpatients & physician offices

Adding CPR to our education prescription

Monitor enrollments to CPR classes from education prescription

Re-survey physician / APN for changes in practice

Investigate & implement CPR Anytime program with inpatients & physician offices

Vision Create and implement an initiative that will increase enrollment in the CPR courses and help to improve the health of our community Promote the important messages about cardiac emergencies and CPR Improve cardiac arrest survival rates by increasing the number trained in bystander CPR Create a program that provides an excellent example of how to work with physicians for a healthier community

Create and implement an initiative that will increase enrollment in the CPR courses and help to improve the health of our community

Promote the important messages about cardiac emergencies and CPR

Improve cardiac arrest survival rates by increasing the number trained in bystander CPR

Create a program that provides an excellent example of how to work with physicians for a healthier community

A Physician CPR Prescription Program provides a mechanism for physicians to: advocate for CPR training increase the number of family members of at-risk patients who recognize the signs of an emergency, know when to phone 911, and know how to perform cardiopulmonary resuscitation (CPR).

A Physician CPR Prescription Program

provides a mechanism for physicians to:

advocate for CPR training

increase the number of family members of at-risk patients who recognize the signs of an emergency, know when to phone 911, and know how to perform cardiopulmonary resuscitation (CPR).

Case for Support! Most cardiac arrests occur in and around the home At-risk population is underserved Power of physician influence is well established

Most cardiac arrests occur

in and around the home

At-risk population is

underserved

Power of physician influence

is well established

How it Works Physicians agree to be a part of the Physician CPR Prescription Program Participating physicians are provided with a description of the Physician CPR Prescription Program and pre-printed CPR prescription pads The patient and/or a family member calls the predetermined contact information for CPR courses being offered and enrolls in a CPR for Family and Friends  course

Physicians agree to be a part of the Physician CPR Prescription Program

Participating physicians are provided with a description of the Physician CPR Prescription Program and pre-printed CPR prescription pads

The patient and/or a family member calls the predetermined contact information for CPR courses being offered and enrolls in a CPR for Family and Friends  course

Rx pad is preprinted with the physician group logo and the information needed to locate an AHA CPR course.

“ Quick Facts” preprinted on backside of Rx to assist physician in delivering the persuasive CPR message to patients and their families.

Theoretical Example 10 physicians participate Each physician provides 100 CPR course referrals over 1 year 400 – 600 learn early warning signs and how to perform CPR

10 physicians participate

Each physician provides 100 CPR course referrals over 1 year

400 – 600 learn early

warning signs and

how to perform CPR

Changes EVERYTHING ! CPR Anytime ™

Changes

EVERYTHING !

What Changes? More barriers removed Increased efficiency Easier to fund/sponsor

More barriers removed

Increased efficiency

Easier to fund/sponsor

Small Pilots in Rhode Island

Pilots South County Cardiology Associates and Cardiovascular Associates of RI Buy-in from senior associates MD RX methods

South County Cardiology Associates and

Cardiovascular Associates of RI

Buy-in from senior associates

MD RX methods

Pilot Goals “Gut check” – see if it works! Further validation of theory Ramp-up for larger study

“Gut check” – see if it works!

Further validation of theory

Ramp-up for larger study

Pilot Results It works! Theory validated Implementers excited!

It works!

Theory validated

Implementers excited!

Endorsement Partner opportunities!

Partner opportunities!

Additional experience will identify an effective means to prompt enrollment in CPR courses Additional work is also needed to determine the overall effectiveness of the initiative

Additional experience will identify an effective means to prompt enrollment in CPR courses

Additional work is also needed to determine the overall effectiveness of the initiative

Further investigation can lead to a method for overcoming factors that prevent healthcare professionals from recommending CPR training to families of at-risk patients. This work will also identify the methods that make CPR training attractive to families and caretakers of at-risk patients.

Further investigation can lead to a method for overcoming factors that prevent healthcare professionals from recommending CPR training to families of at-risk patients.

This work will also identify the methods that make CPR training attractive to families and caretakers of at-risk patients.

Materials Created PowerPoint Guide Templates Marketing Collateral Press Release http:/www.mari-ecc.org

PowerPoint

Guide

Templates

Marketing Collateral

Press Release

Summary We can impact lives saved! Patients & families want us to discuss CPR Families are uncomfortable with their CPR skills We can overcome barriers We can impact number of families trained Alternative innovative options need to be explored CPR Prescription & CPR Anytime have a role

We can impact lives saved!

Patients & families want us to discuss CPR

Families are uncomfortable with their CPR skills

We can overcome barriers

We can impact number of families trained

Alternative innovative options need to be explored

CPR Prescription & CPR Anytime have a role

Questions

Judy Vierke, RN, MS, CCNS Manager of Education & Prevention Edward Heart Hospital 630-527-2830 [email_address] David Hiltz, NREMT-P Senior Regional Manager American Heart Association 401-330-1721 [email_address]

Judy Vierke, RN, MS, CCNS

Manager of Education & Prevention

Edward Heart Hospital

630-527-2830

[email_address]

David Hiltz, NREMT-P

Senior Regional Manager

American Heart Association

401-330-1721

[email_address]

References Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science. Circulation . 2000;102(suppl I):I-8 Guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC). JAMA . 1992;286:2135-2302 Chu KH, May CR, Clark MJ, Breeze KM. CPR training in households of patients with chest pain. Resuscitation. 2003;57:257-268. Dracup K, Moser DK, Taylor SE, Guzy PM. The psychological consequences of cardiopulmonary resuscitation training for family members of at risk for sudden death. Am J Public Health . 1997;87:1434-1439 Dracup K, Moser DK, Taylor SE, Guzy PM, Marsden C. Is cardiopulmonary resuscitation training deleterious to family members of at risk patients? Am J Public Health. 1994;84:116-118 Dracup K, Heany DM, Taylor SE, Guzy PM, Breu C. Can family members of high-risk patients learn cardiopulmonary resuscitation? Arch Intern Med . 1989;149:61-64

Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science. Circulation . 2000;102(suppl I):I-8

Guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC). JAMA . 1992;286:2135-2302

Chu KH, May CR, Clark MJ, Breeze KM. CPR training in households of patients with chest pain. Resuscitation. 2003;57:257-268.

Dracup K, Moser DK, Taylor SE, Guzy PM. The psychological consequences of cardiopulmonary resuscitation training for family members of at risk for sudden death. Am J Public Health . 1997;87:1434-1439

Dracup K, Moser DK, Taylor SE, Guzy PM, Marsden C. Is cardiopulmonary resuscitation training deleterious to family members of at risk patients? Am J Public Health. 1994;84:116-118

Dracup K, Heany DM, Taylor SE, Guzy PM, Breu C. Can family members of high-risk patients learn cardiopulmonary resuscitation? Arch Intern Med . 1989;149:61-64

References Goldberg RJ, Gore JM, Love DG, Ockene JK, Dalen JE. Layperson CPR – Are we training the right people? Annals of Emergency Medicine. 1984; 13:9:89-92. Goldberg RJ, DeCosimo D, St. Louis P, Gori JM, Ockene JK, Dalen JE. Physicians’ attitudes and practices toward CPR training in family members of patients with coronary heart disease. AJPH. 1985;75:281-283. Platz E, Scheatzle MD. Pepe PE, Dearwater SR. Attitudes towards CPR training and performance in family members of patients with heart disease. Resuscitation. 2000.;47:273-280. http://www.ajph.org/cgi/content/abstract/87/9/1434

Goldberg RJ, Gore JM, Love DG, Ockene JK, Dalen JE. Layperson CPR – Are we training the right people? Annals of Emergency Medicine. 1984; 13:9:89-92.

Goldberg RJ, DeCosimo D, St. Louis P, Gori JM, Ockene JK, Dalen JE. Physicians’ attitudes and practices toward CPR training in family members of patients with coronary heart disease. AJPH. 1985;75:281-283.

Platz E, Scheatzle MD. Pepe PE, Dearwater SR. Attitudes towards CPR training and performance in family members of patients with heart disease. Resuscitation. 2000.;47:273-280.

http://www.ajph.org/cgi/content/abstract/87/9/1434

Thank You!