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CPR: Training and Survey
Focus
CAROL SIEM RN, MSN, GNP, BC Clinical Educator
CPR – DNR - TV
What does the public see???
- MASH
- ER George Clooney
- Night Shift
- Nurse Jackie
- Miracles in one hour
CPR – DNR – TV
Comic Version
https://www.youtube.com/watch?v=F nAOmxnQJsM
History of CPR
1740 The Paris Academy of Sciences officially recommended mouth-to- mouth resuscitation for drowning victims. 1767 The Society for the Recovery of Drowned Persons became the first organized effort to deal with sudden and unexpected death.
History
1891 Dr. Friedrich Maass performed the first equivocally documented chest compression in humans. 1903 Dr. George Crile reported the first successful use of external chest compressions in human resuscitation. 1904 The first American case of closed-chest cardiac massage was performed by Dr. George Crile.
History
1954 James Elam was the first to prove that expired air was sufficient to maintain adequate oxygenation. 1956 Peter Safar and James Elam invented mouth-to-mouth resuscitation.
History
1957 The United States military adopted the mouth-to- mouth resuscitation method to revive unresponsive victims 1960 Cardiopulmonary resuscitation (CPR) was developed. The American Heart Association started a program to acquaint physicians with close-chest cardiac resuscitation and became the forerunner of CPR training for the general public
History
1960: First documentation of 14 patients who survived cardiac arrest with the application of closed chest cardiac massage.
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Updated Oct 18, 2013 Revised Jan 1, 2015 Can be found at: http://www.cms.gov/Medicare/Provid er-Enrollment-and- Certification/SurveyCertificationGenInf o/Downloads/Survey-and-Cert-Letter- 14 - 01.pdf
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Surveyor guidance in Appendix PP was revised to clarify CPR policies for nursing homes Regulatory language is unchanged
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Memorandum Summary
Initiation of CPR - Prior to the arrival of emergency medical services (EMS), nursing homes must provide basic life support, including initiation of CPR, to a resident who experiences cardiac arrest (cessation of respirations and/or pulse) in accordance with that resident’s advance directives or in the absence of advance directives or a Do Not Resuscitate (DNR) order. CPR-certified staff must be available at all times.
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Memorandum Summary
Facility CPR Policy - Some nursing homes have implemented facility-wide no CPR policies. Facilities must not establish and implement facility-wide no CPR policies.
Guidelines
Part 3: Ethics
Withholding and withdrawing CPR exceptions: Attempts to perform CPR would place the rescuer at risk of serious injury or mortal peril Obvious clinical signs of irreversible death (eg. Rigor mortis, dependent lividity, decapitation, transection, or decomposition) Valid, signed and dated advance directive indication no resuscitation
Guidelines
Part 3: Ethics
Termination of Resuscitative Efforts
- Restoration of effective, spontaneous circulation
- Care is transferred to a team providing advanced life support
- Rescuer is unable to continue because of exhaustion, environmental hazards or because continuation puts others in jeopardy
Definitions
Rigor Mortis: stiffening of the body, 1 to 7 hours after death, from hardening of the muscular tissues in consequence of the coagulation of the myosinogen and paramyosinogen, it disappears after 1 to 6 days or when decomposition begins Dependent lividity:
Definitions
Dependent lividity: A purple coloration of the dependent parts, except in areas of contact pressure, appearing within one half to two hours after death, as a result of gravitational movement of blood within the vessels
Resuscitation Science
Importance
Properly delivered chest compressions to create blood flow to the heart and brain. Effective chest compressions consist of using the correct rate and depth of compression and allowing for complete recoil of the chest. “Staying Alive”
Mock Codes
https://www.youtube.com/watch?v=E MAH_-SWrrg
Mock Code
Hospital vs. Nursing Home
- Crash Cart vs Emergency Cart
- Basic CPR vs Advanced Life Support
Emergency Cart
Back board Face mask Ambu bag Suction / Yankauer set up Oxygen tank with necessary supplies Gloves AED (if available)
Emergency Cart
Where is it kept? All staff know the location Who checks the cart to ensure the proper equipment is on the cart and it works. Watch for Expiration Dates These checks need to be part of your QA Program
Code Status
How does staff know??
- Be consistent
- Assign responsibility to ensure all steps are in place
Code Discussion
Who does it??? Is it a frank discussion?? What terms are used: Do Not Resuscitate or Allow Natural Death
Code Discussion
How often is the topic/status reviewed? Should be reviewed at least with each care plan meeting and with a significant change.
Resources:
http://www.hospicepatients.org/and.h tml http://usatoday30.usatoday.com/news /health/2009- 03 - 02 - DNR-natural- death_N.htm http://dph.georgia.gov/sites/dph.georg ia.gov/files/POLST%20%28Final%206. 2012%29_090612.pdf
