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Margaret Allwood - RESUS4KIDS
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Margaret Allwood - RESUS4KIDS


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A presentation given by margaret Allwood at teh 2012 CHA Conference, The journey, in the 'Innovations in Supporting Acutely Unwell Children, Young People & Their Families' stream.

A presentation given by margaret Allwood at teh 2012 CHA Conference, The journey, in the 'Innovations in Supporting Acutely Unwell Children, Young People & Their Families' stream.

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  • RESUS4KIDS is a peadiatric life support package designed for health care professionals caring for children in the acute environment. The National Safety and Quality Health Service Standards require health care facilities to establish and maintain systems for recognising and responding to clinical deterioration. RESUS4KIDS is a program that enables facilities to meet part of this standard.
  • R4K is funded by the Ministry of Health, and is currently in phase 3 of implementation, with rollout in public hospitals across NSW currently under way.
  • Courses are free for participants to attend, and there is no financial benefits to any members of the R4k team.
  • The national Safety and Quality Health Service Standards consists of 10 standards that aim to protect the public from harm and to improve quality of health service provision. The Standards are integral to the accreditation process as they determine minimum standards of safety and quality that a facility must meet. The Standards have been designed for use by all health services.
  • Standard 9 of the National Safety and Quality Health Services Standards deals with recognising and responding to clinical deterioration in acute health care. The intention of this Standard is to:Ensure a patient’s deterioration is recognisedpromptly, and appropriate action is taken. This Standard applies to all patients in acute healthcare facilities including adults, adolescents, children and babies. As health care professionals it is expected that we are able to identify when our patients are deteriorating, and act appropriately. We need to be able to respond to the arresting child, and initiate actions to resuscitate that child.
  • The guidelines also talk about the importance of teamwork and communication during an arrest, and how simulation training can assist in improving resuscitation skills.
  • Criterion 3 of Standard 9 lists the items and actions required to respond to clinical deterioration. The workforce needs to be trained and proficient in basic life support. All clinicians must be capable of delivering basic life support while waiting for emergency assistance. Poor quality resuscitation leads to reduced outcomes for patients.
  • Facilities need to ensure that rapid response systems give access to a clinician who can provide advanced life support. Clinicians need training and education in order to be able to learn and maintain life support skills, and this is where RESUS4KIDS comes in.
  • So What is RESUS4KIDS? RESUS4KIDS is paediatric life support program for health care rescuers. It teaches clinicians paediatric life support skills required to support an arrested child. RESUS4KIDS only focuses on the first 10 mins of the arrest, and it does not focus on post resuscitation care. The program reflects the ARC guidelines, and includes a 90 minute e-learning component followed by a 90 minute practical session.
  • RESUS4KIDS is NOT a mandated course, but will be a pre-requisite or co-requisite for DETECT Junior. DETECT Junior is a NSW health initiative that teaches clinicians on the recognition and management of clinical deterioration in paediatric patients. Some healthcare facilities have elected to make RESUS4KIDS mandatory, and have replaced their previous annual paediatric life support training with RESUS4KIDS. The feedback has been really positive, with participants saying RESUS4KIDS is a course they enjoyed attending, and trainers want to teach. Health care providers who have attended RESUS4KIDS all acknowledge that it is a course that can only benefit the critically ill children we care for, and give us the knowledge and skills required in an arrest situation.
  • RESUS4KIDS is delivered in 2 parts – the e-learning and the practical session. The e-learning takes about 90 mins to complete, and has a pre and post course test. Participants who complete and pass the post-course test receive a certificate of completion. The e-learning provides essential pre-learning, and cuts down on the time needed for the practical session. It can be completed in stages, as the program saves the data as you go. In addition to the 9 compulsory modules, there are additional optional modules exploring abnormal rhythms, the EZ-IO drill, and the 4H’s and 4T’s.
  • The e-learning is interactive, and requires input from the participant in order to be able to progress through the modules. The participant is walked through the RESUS4KIDS algorithm of DRSABCD, and the actions and interventions involved at each step. The e-learning can be accessed via the internet at the web address at the top of the slide –
  • The e-learning contains videos demonstrating how to perform certain techniques, providing the participant with the necessary information to then attend the practical session. The e-learning must be completed, and the post course test passed before attendance at a short practical session.
  • Further e-learning modules are currently being developed and include a module dealing with intubation and LMA’s. A train the Trainer module will be released shortly to enable trainers to remain current and up to date with their knowledge and skills.
  • The short practical course consists of 2 components – 30 mins where the focus is on teamwork and communication, followed by 1 hour working through 3 short scenarios of an arrested child. One of the features of this program is that the groups are kept to 6 participants, meaning everyone gets a turn at the practical skills, and the facilitator gets the opportunity to continually assess and feedback each participant.
  • The first part of the practical course focuses on teamwork and communication. The National Safety and Quality Health Service Standards recommend improving non-technical skills such as teamwork, leadership, structured communication and task to improve the performance of resuscitation providers. RESUS4KIDS uses an interactive tennis ball game to encourage discussion around the use of names, resource utilisation, appropriate roles, and team member participation. A dramatised video clip is then viewed, which highlights the principles of leadership, communication, language and roles.
  • The RESUS4KIDS session then moves on to use pause and discuss scenario based teaching. Participants work through 3 scenarios, pausing and discussing elements of the algorithm. Standard 9 of the National Safety and Quality Health Service Standards states simulation training can assist in improving both technical and non-technical skills, which may help to improve patient survival. Each participant is required to demonstrate the individual clinical skills of the algorithm. Participants are also required to recognise and identify treatment for shockable and non-shockable cardiac rhythms.
  • RESUS4KIDS has a train the trainer course, which is run by a supertrainer and allows individual facilities to have their own RESUS4KIDS trainers who can then independantly run the course. In this way, RESUS4KIDS can be run anywhere, anytime as long as there is a trainer available.
  • Barriers to the program include knowing which staff to engage. As with any program, it is a good idea to have your first audience leave with a positive impression, so they will then feed this enthusiasm back to their colleagues. It is important to know who to approach from management for support. Without managerial support, it is very difficult to have staff released to attend the course. As RESUS4KIDS is not a mandated course, it can be difficult to gain managerial support due to time and funding constraints.
  • I’m now going to talk about a few places where RESUS4KIDS has been adopted, and how this has been achieved. The John Hunter Children’s Hospital is co-located with the John Hunter Hospital in Newcastle, NSW. It is a paediatric tertiary referral hospital, with 113 beds including a paediatric medical ward, surgery/oncology ward, adolescent/day stay ward, sleep unit, neonatal intensive care unit, outpatient clinic and school room. With approximately 20,000 ED presentations and over 8,500 admissions per year, the JHCH provides services to about 20% of NSW’s population of children aged up to 16 years.
  • In February this year, we began the implementation of RESUS4KIDS at the John Hunter Children’s Hospital. The program was made mandatory for all nursing staff and replaced the previously offered basic life support training. Support was gained from both medical and nursing managers, and staff were notified of the session they were enrolled in and told they were expected to attend. We hoped to get most people through the program before the busy winter months made time for education more difficult. It was the responsibility of the individual staff member to complete the e-learning prior to their session, and no time was allocated for this to be done at work.
  • In addition to three scheduled RESUS4KIDS sessions each week, we made sure RESUS4KIDS was part of the program for any planned study days. New staff are to attend RESUS4KIDS as part of their orientation. In April, many of our local staff specialists attended a conference in Kings Canyon, NT
  • Before they went, we trained 3 volunteers as RESUS4KIDS trainers, and they presented RESUS4KIDS in a shed at a cattle station in Kings Canyon. This was a great opportunity, as it meant these medical experts could practise their resus skills in a non- threatening environment with their colleagues.
  • In seven months, the JHCH has reached 85% compliance with RESUS4KIDS, and have held over 40 sessions with more than 230 participants. Feedback from the staff has been positive, with most people saying RESUS4KIDS has increased their confidence in their ability to provide paediatric resuscitation.
  • The paediatric ward employs 22 RN’s, and sees about430 admissions per year. They implemented R4K in March this year, and have reached nearly 100% compliance with only 3 staff members still to complete the program.
  • The University of Newcastle has adopted RESUS4KIDS for both their medical and nursing undergraduate programs. The department of medicine was approached and told about the program. After key stakeholders had completed RESUS4KIDS, the decision was made to incorporate the program into the undergraduate medical degree. A TTT was held for the university staff, and they are now independent in delivering the program. The Nursing faculty was approached in the same way. The University of Newcastle is currently re-writing their undergraduate nursing degree, and after meeting with course coordinators they decided to include RESUS4KIDS in the new program. Both faculties like the fact that RESUS4KIDS is available to both uni students and health care professionals, and is a “real” program for the students to experience. As of next year, all third year nursing students, and 4th year medical students will be required to complete RESUS4KIDS as a compulsory requirement of their degree.
  • The success of RESUS4KIDS is not limited to the Hunter, but is reflected across NSW. Over 6000 people have completed the e-learning, and nearly 3000 people have attended a short practical course. We now have 406 trainers across the state, and NSW ambulance, NSW local health districts, ACT, University of NSW and University of Sydney have all taken up the RESUS4KIDS program.
  • RESUS4KIDS is available to other Australian states for public health employees at a minimal cost (?$). Commercial arrangements can be made for private hospitals and overseas hospitals.
  • Sponsorship from companies such as Laerdal enable national progression of the program
  • Transcript

    • 1. Project Manger: Dr Fenton O’Leary RESUS4KIDS - Responding to clinical deterioration. Implementing the National Safety & Quality Health Service Standards Margaret Allwood RESUS4KIDS NURSE EDUCATOR
    • 2. Project Manger: Dr Fenton O’Leary Acknowledgements • Karyn Fahy – Western Child Health Network Coordinator • Elizabeth Koff – Executive sponsor • Phase 1 (Jan – June 2009) project team – Marino Festa, Julie Howse • Phase 2 (Sept 2010 – June 2011) project team – Kathryn Green, Kelly Dart, Melinda Simpson-Collins • Phase 3 (Current) project team - Leanne Crittenden, Margaret Kelly, Kathryn McGarvey, Margaret Allwood, Anne Sivell, Natalie Law, Jessica Hennessy, Louise Austin • Phase 1 and 2 Steering Committees • New South Wales Child Health Network Clinical Nurse Consultants • RESUS4KIDS instructors (the enthusiastic experts) and their managers • The Ministry of Health – Trish Boss; Trish Davidson NCHN Covenor
    • 3. Project Manger: Dr Fenton O’Leary Conflict of Interest RESUS4KIDS is a Child Health Network project funded by The New South Wales Ministry of Health No financial interest by any of the team Courses are free to attend for participants No cost to facilities in New South Wales
    • 4. Project Manger: Dr Fenton O’Leary National Safety and Quality Health Service Standards • 10 standards • Primary aims of the standards are to protect the public from harm and to improve quality of health service provision
    • 5. Project Manger: Dr Fenton O’Leary
    • 6. Project Manger: Dr Fenton O’Leary
    • 7. Project Manger: Dr Fenton O’Leary
    • 8. Project Manger: Dr Fenton O’Leary
    • 9. Project Manger: Dr Fenton O’Leary What is RESUS4KIDS?
    • 10. Project Manger: Dr Fenton O’Leary What is RESUS4KIDS? Not a ‘mandated’ course • A course participants want to attend • A course trainers want to teach • A course managers want their staff to attend and teach • A course that will benefit the care of children when they are critically ill and in need of practitioners who are knowledgeable, confident and technically able
    • 11. Project Manger: Dr Fenton O’Leary RESUS4KIDS – E-Learning • Essential pre-learning • New knowledge • Revise knowledge • Simple skill practice • Interactivity • Knowledge test • Recent optional lessons – EZ-IO Drill – 4Hs and 4Ts – Abnormal rhythms
    • 12. Project Manger: Dr Fenton O’Leary
    • 13. Project Manger: Dr Fenton O’Leary
    • 14. Project Manger: Dr Fenton O’Leary Further E-Learning • Intubation and Laryngeal mask airway • Train the Trainer module
    • 15. Project Manger: Dr Fenton O’Leary The short practical course Two components – Team work and communication (30 mins) – Pause and discuss scenario based teaching (60 mins)
    • 16. Project Manger: Dr Fenton O’Leary Team work and Communication Specific learning points • Display and use names • Recognisable team leader • Team members participation • Allocate / accept roles • Concise, clear communication, closed loop communication
    • 17. Project Manger: Dr Fenton O’Leary Pause and discuss scenario based teaching Specific learning points • Managing an infants or child’s airway • Performing effective breathing • Demonstrate effective cardiac compressions • Recognise and initial treatment of shockable and non-shockable cardiac rhythms • Perform safe defibrillation
    • 18. Project Manger: Dr Fenton O’Leary Governance • Participant courses • Train the trainer courses • Super trainer courses
    • 19. Project Manger: Dr Fenton O’Leary Barriers • Knowing who to engage • Releasing staff for courses • Competition with ‘mandated’ courses • Model for sustainability
    • 20. Project Manger: Dr Fenton O’Leary John Hunter Children’s Hospital – Newcastle NSW • Paediatric tertiary referral hospital • 113 tertiary beds • One of three children’s hospitals in NSW
    • 21. Project Manger: Dr Fenton O’Leary Implementation • RESUS4KIDS mandatory for all paediatric nursing staff • Managerial support – DON, NUM’s, medical • Rapid implementation • Opportunistic sessions • Staff allocated and notified of the session they were expected to attend
    • 22. Project Manger: Dr Fenton O’Leary Opportunistic education • Hunter Paediatric Society – Kings Canyon conference, 2012 • 3 trainers • 25 staff specialists
    • 23. Project Manger: Dr Fenton O’Leary Kings Canyon - 2012
    • 24. Project Manger: Dr Fenton O’Leary Results • Commenced February 2012 • Over 40 RESUS4KIDS sessions • 160 nursing staff (85% compliance) • 74 medical staff • 10 active trainers • 2 supertrainers
    • 25. Project Manger: Dr Fenton O’Leary The Maitland Hospital - NSW • Rural referral hospital • 12-16 paediatric beds
    • 26. Project Manger: Dr Fenton O’Leary The University of Newcastle • 2013 - compulsory part of the undergraduate nursing degree • Compulsory component of 4th year medical student requirements
    • 27. Project Manger: Dr Fenton O’Leary RESUS4KIDS Results • As of June 2012: • 6468 completed e-learning • 2917 completed short practical course • 406 trainers • Uptake from NSW Ambulance, NSW local health districts, ACT, University of NSW, University of Sydney, University of Newcastle, Sunshine Coast Health, University of Tasmania paramedic Practice
    • 28. Project Manger: Dr Fenton O’Leary The Future - Elsewhere • RESUS4KIDS is available to other Australian jurisdictions for public health employees for minimal set up costs. • Commercial arrangements for private healthcare facilities and overseas institutions
    • 29. Project Manger: Dr Fenton O’Leary Sponsorship • $7,500 from Laerdal
    • 30. Project Manger: Dr Fenton O’Leary Questions ?