The American Heart Association named UAB Hospital as an AHA RQI Verified institution at a ceremony on Dec. 19. The RQI program — Resuscitation Quality Improvement — is a national campaign to improve in-hospital cardiopulmonary resuscitation. UAB was the third hospital in the nation to launch an RQI program and will be the first in the United States to begin using the newest version, RQI-2020.
“Emergency department staff at hospitals across the country are required to undergo CPR recertification every two years, but studies have shown that their skills begin to degrade the moment the training session ends, and most people have lost effective skills within 90 days,” said Michael Kurz, M.D., associate professor in the Department of Emergency Medicine. “The RQI program allows us to approach CPR training in a whole new way, and we are seeing remarkable improvement.”
The RQI system consists of two sophisticated mannequins — one adult and one pediatric — attached to an even more sophisticated computer system. The machines measure all the variables involved with performing CPR and provide instantaneous feedback as a staff member is practicing. UAB trains emergency department staff on the machines every 90 days.
“It is not enough to simply know CPR,” said Julie Frain, impact manager for RQI Partners, the firm implementing the program. “Healthcare professionals need to perform high-quality CPR on every patient, every time. We now know that low-dose, high-frequency learning practices are significantly more effective at increasing competency. RQI shifts from a traditional 2-year compliance mindset to one of mastery learning with verified skills competency – centered on patient safety – establishing a new standard of care for transformational quality improvement and more lives saved.”
Frain says that there are more than 200,000 in-hospital cardiac arrests annually in the United States, and fewer than 26 percent of these patients survive.
In the UAB emergency department, the new training regimen calls for nurses and patient care technicians to undergo 10-minute updates every three months, using different modules that work on different skill sets. The computer records trainees’ performance and tracks their improvement over time. It even records whether trainees have placed their hands in the proper position on the mannequin.
“The machine measures variables such as depth of the CPR compression, the rate and the recoil, and the trainee can see on the screen whether they are reaching the appropriate benchmarks in these areas,” said Michael Lovelace, R.N., an emergency department nurse and lead CPR trainer.
Kurz, who is the vice chair for the Systems of Care subcommittee for emergency cardiovascular care committee with the Heart Association, says training every three months rather than at two-year intervals has made a significant difference.
“Retention of the skills is better; performance is better,” Kurz said. “One important variable is chest compression fraction, which measures the efficiency of the CPR. Before we began using the RQI machines, our chest compression fraction score was about 72. It’s now up over 90. The RQI machines are having a major impact on enhancing our clinical care.”
Lovelace knows first-hand the benefit of high-quality CPR. While conducting a CPR training in April 2017 for UAB res ident physicians, he began to feel ill. He drove himself to the UAB emergency department where it was quickly determined that he was having a heart attack.
His heart stopped — he ‘coded’ in the parlance of the nursing profession — and the ED staff, the very people that he trained on a regular basis, leapt into action.
“When I regained consciousness, I had 11 broken ribs because someone, actually several someones, had done high-quality CPR on me and saved my life.” Lovelace said. “Because of RQI, they were confident and competent in their skills. I’m now living motivation for every health care professional to learn and maintain their proficiency in CPR, and RQI helps that happen.”
Lovelace and Kurz plan to expand the RQI training program to other units in UAB Hospital.