· Web view: A basic emergency procedure for life support, consisting of mainly manual external cardiac massage and some artificial respiration. Cardiac arrest : Defined as the cessation

INDEX

S.NO

Topic Annexure No. Page

1. Glossary 2-32. CPR committee /Code blue team / Emergency codes Annexure-1 43. Crash Cart trolley Annexure-2 54. Standardized List of Crash Cart Annexure-3 65. BLS Training 2015,2016,2017 Annexure-4a 76. ACLS Training 2015,2016,2017 Annexure-4b 87. Code Blue Performa Annexure-5 98. Six Sigma-DMAIC Annexure-6 109. Cardio Pulmonary Resuscitation Analysis

– Year 2015-2016Annexure-7 11

10. Cardio Pulmonary Resuscitation Analysis – Year 2016-2017

Annexure-8 12

11. Code Blue activated vs. Cardio Pulmonary Respiratory Arrest -2015/2016/2017

Annexure-9 13

12. Code Blue team arrive within 3 min (%) Annexure-10 1413. Return of Spontaneous Circulation (ROSC)

after CPR (%)Annexure-11 15

14. Discharged after ROSC (%) Annexure-12 1615. Logistic Checklist (Code Blue Performa)-

2015/2016/2017Annexure-13a/13b

17-18

1

Glossary :

Advanced Cardiovascular Life Support (ACLS): Emergency medical procedure in which basic life support efforts of CPR are supplemented with drug administration, Iv fluids, etc .

Basic Life Support (BLS): Emergency treatment of a victim of cardiac or respiratory arrest through cardiopulmonary resuscitation and emergency cardiovascular care .

Code Blue: A declaration of or a state of medical emergency and call for medical personnel and equipment to attempt to resuscitate a patient especially when in cardiac arrest or respiratory distress or failure.

CPR: A basic emergency procedure for life support, consisting of mainly manual external cardiac massage and some artificial respiration.

Cardiac arrest: Defined as the cessation of cardiac mechanical activity as confirmed by lapse in circulation, which was determined by the absence of a palpable central pulse.

Continual Quality Improvement : CQI is serial experimentation (the scientific method) applied to everyday work to meet the needs of those we serve and improve the services we offer.

Return of Spontaneous Circulation (ROSC): is resumption of sustained perfusing cardiac activity associated with significant respiratory effort after cardiac arrest

References:

In-hospital cardiac arrest is an emergency situation that requires teamwork and the appropriate sequential actions to rescue the patients.[1]despite considerable efforts to improve the treatment of cardiac arrest, most reported survival outcome figures are poor.[2] Even in the hospitalised patients, the rate of successful CPR has been reported by some studies to be as low as 2–6%, although most studies report successful CPR outcome in the range of 13–59%.[3,4]

2

Very few studies are available in the literature on comparative CPR outcomes after formal resuscitation training. An in-hospital investigation demonstrated that cardiac arrest detected by an ACLS-trained nurse was strongly associated with a four-fold increase in survival to discharge

(38% vs. 10%) than those detected by a nurse without ACLS training.[5] This indicates that ACLS-trained nurses provided an independent contribution to increased survival rate.

Successful resuscitation after cardiac arrest requires early recognition of cardiac arrest, rapid activation of trained responders, timely initiation of BLS, early defibrillation and early ACLS.[6] In accordance with a few data available in the literature, our study reveals that formal training of the CPR team drastically improves the survival rates and survival to hospital discharge rates following resuscitation of cardiac arrest victims. We conclude that formal certified BLS and ACLS training courses with hands-on practice and their periodic renewal are crucial in improving the outcomes of CPR.

Study by Saket Girotra, for the American Heart Association Get with the Guidelines–Resuscitation Investigators in “Trends in Survival after In-Hospital Cardiac Arrest “shows that the overall rate of survival to discharge improved significantly from 13.7% in 2000 to 22.3% in 2009. [7]

Biblography1. Krittayaphong R, Saengsung P, Chawaruechai T, Yindeengam A, Udompunturak S. Factors predicting outcome of cardiopulmonary resuscitation in a developing country: The Siriraj cardiopulmonary resuscitation registry. J Med Assoc Thai. 2009;92:618–23.[PubMed]2. Jacobs I, Nadkarni V, Bahr J, Berg RA, Billi JE, Bossaert L, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries. A statement for healthcare professionals from a task force of the international liaison committee on resuscitation. (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa) Resuscitation. 2004;63:233–49. [PubMed]3. Borimnejad L, Nasrabadi AN, Mohammadi H, Kheirati L. Improving the outcomes of CPR: A report of a reform in the organization of emergency response. Internet J Emer Med. 2008;4:2.4. Berger R, Kelley M. Survival after in-hospital cardiopulmonary arrest of noncritically ill patients. Chest. 1994;106:872–9. [PubMed]5. Dane FC, Russell-Lindgren KS, Parish DC, Durham MD, Brown TD. In-hospital resuscitation: Association between ACLS training and survival to discharge. Resuscitation. 2000;47:83–7. [PubMed]6. Doig CJ, Boiteau PJ, Sandham JD. A 2-year prospective cohort study of cardiac resuscitation in a major Canadian hospital. Clin Invest Med. 2000;23:132–43. [PubMed]7. Saket Girotra, M.D., Brahmajee K. Nallamothu, M.D., M.P.H., John A. Spertus, M.D., M.P.H., Yan Li, Ph.D., Harlan M. Krumholz, M.D., and Paul S. Chan, M.D., for the American Heart Association Get with the Guidelines–Resuscitation Investigators.

3

Annexure-1

Cardio Pulmonary Resuscitation Committee-Members Code Orange-Medical Emergency Paediatric

*5777

Dr. B.K. Rao, Chairperson Chairperson - Deptt. of Critical Care &

Emergency MedicinePaediatric ICU Registrar on Duty

Dr.Reena Kumar A.D.M.SNursing Supervisor

Dr. Ashwini Mehta Sr. Consultant, CardiologyNursing Supervisor

Dr. Suresh Gupta Sr. Consultant, PaediatricsDMS on Duty

Dr. Debashish Dhar Sr. Consultant, PaediatricsECG Technician

Dr. Jyoti DMS & In-charge - QualityTelephone Exchange

Ms. Usha Pandey Chief Nursing Officer

Code BLUE-Cardiopulmonary Arrest

*5111 Code Indigo-Medical Emergency Neonatal

*5999

ICU CONSULTANT Neonatology ICU Registrar on duty

ICU REGISTRAR Nursing Supervisor

CARDIOLOGY REGISTRAR Nursing Supervisor

DMS ON DUTY DMS on Duty

NURSING SUPERVISOR ECG Technician

TELEPHONE EXCHANGE Telephone Exchange

4

Annexure-2

5

Annexure-3

Standardized List of Crash Cart – Uniform in all locations

6

Annexure-4a

BLS Training 2015/2016/2017

Categories of staff 2015 2016 2017 Total

Doctor 200 440 98 738Nurses 500 800 210 1510

Paramedical Staff 109 150 40 299Grand Total 811 1396 348 2555

2015 2016 2017 Total0

500

1000

1500

2000

2500

3000

200440

98

738500

800

210

1510

109 150 40299

811

1396

348

2555

Staff trained on BLS-2015/2016/2017

Doctor Nurses Paramedical Staff Grand Total

No.

of s

taff

7

Annexure-4b

ACLS Training 2015/2016/2017

Categories of staff 2015 2016 2017 Total

Doctor 102 240 60 402

Nurses 367 605 200 1172

Grand Total 471 851 230 1552

2015 2016 2017 Total0

200400600800

1000120014001600

102240

60

402367605

200

1172

471

851

230

1552

Staff trained on ACLS-2015/2016/2017

Doctor Nurses Grand Total

No.

of s

taff

8

Annexure-5

9

Six Sigma-DMAIC Annexure-6

10

DEFINEContinual improvement in Revival & Survival rate after CPR in tertiary care super speciality hospitalMEASURENumber of code blue in wardsCPR Arrest Team arrival time –within 3 min.Return of Spontaneous Circulation (ROSC)after CPR No of patients discharged ANALYSEAnalysis of data captured in event forms and identifying challengesIMPROVE Use of checklist to ensure availibility of logistics in all locationsAlgoritham displayedEarly recognition of the event & immediate activation of the code blue response achieved by training .All categories of staff were trained to intiate basic CPR before arrival of code blue team s.Quality of CPR delivered Reviewed in CPR committe to bring in the efficiencies through mix of innovative approach, expertise and perseverance by addressing the challenges CONTROLDocumentation of SOP Training on BLS/ACLS to all healthcare workers in direct contact with the patient By conducting Code blue mock drills and debriefing of every code blue.Use of checklist for structure and process in place Auditing (code blue proforma)Reviewing by CPR committe for trend analysis, gaps and suggesting method to improve.

Annexure-7

CARDIO PULMONARY RESUSCITATION ANALYSIS - YEAR 2015-2016Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16

 No. of

Cases

% of cases

No. of

Cases

%age of

cases

No. of

Cases

%age of

cases

No. of

Cases

%age of

cases

No. of

Cases

%age of

cases

No. of

Cases

%age of

cases

No. of

Cases

%age of

cases

No. of

Cases

%age of

cases

No. of

Cases

%age of

cases

No. of

Cases

%age of

cases

No. of

Cases

%age of

cases

No. of

Cases

%age of

cases

Total no. of Code Blue activated

14 10 17 12 7 4 9 18 14 23 22 16

Team arrival time –within

3min13 92.8

6 10 100 15 88.24 12 100 7 100 2 50 6 66.6

7 18 100 13 92.86 19 82.6

1 20 90.91 14 87.5

0

Cardio Pulmonary Respiratory

Arrest

9 64.29 7 70 10 58.8

2 6 50.00 5 71.4

3 1 25.00 4 44.44 12 66.6

7 7 50.00 21 91.3

0 14 63.64 11 68.7

5

Return of spontaneous

circulation (ROSC)after

CPR

4 44.44 3 42.8

6 3 30.00 2 33.3

3 1 20.00 0 0.00 0 0.00 4 33.3

3 4 57.14 7 33.3

3 5 35.71 6 54.5

5

Patients Discharged 0 0.00 1 14.2

9 2 20.00 1 16.6

7 0 0.00 0 0.00 2 50.00 2 16.6

7 1 14.29 4 19.0

5 2 14.29 1 9.09

11

Annexure-8

CARDIO PULMONARY RESUSCITATION ANALYSIS - YEAR 2016-2017 

Apr-16 

May-16 

Jun-16 

Jul-16 

Aug-16 

Sep-16 

Oct-16 

Nov-16 

Dec-16 

Jan-17 

Feb-17 

Mar-17

No. of

Cases

%age of case

s

No. of

Cases

%age of case

s

No. of

Cases

%age of case

s

No. of

Cases

%age of case

s

No. of

Cases

%age of case

s

No. of

Cases

%age of case

s

No. of

Cases

%age of case

s

No. of

Cases

%age of case

s

No. of

Cases

%age of

cases

No. of

Cases

%age of case

s

No. of

Cases

%age of case

s

No. of

Cases

%age of case

sTotal no. of Code

Blue activated

13   16   13   15   14.00   16   10   14   12   14   13   16  

Team arrival time –within 3min

11 84.62 13 81.2

5 13 100 13 86.67 12 85.7

1 15 93.75 8 80.0 14 100 12 100 14 100 13 100 15 93.7

5

Cardio Pulmonary Respirator

y Arrest

11 84.62 14 87.5

0 7 53.85 12 80.0

0 9.00 64.29

15.00

93.75 9 90.0

0 13 92.86 12 100.0

0 11 78.57 11 84.6

2 15 93.75

Return of spontaneo

us circulation (ROSC)afte

r CPR

5 45.45 7 50.0

0 1 14.29 5 41.6

7 3.00 33.33 7.00 46.6

7 4 44.44 4 30.7

7 2 16.67 4 36.36 7 63.6

4 6 40.00

Patients Discharged 3 27.2

7 4 28.57 4 57.1

4 2 16.67 2.00 22.2

2 6.00 40.00 2 22.2

2 2 15.38 6 50.00 4 36.3

6 2 18.18 5 33.3

3

12

Annexure-9

Code Blue activated vs. Cardio Pulmonary Respiratory Arrest -2015-2016,2017   Apr-

15May-

15Jun-15

Jul-15

Aug-15

Sep-15

Oct-15

Nov-15

Dec-15

Jan-16

Feb-16

Mar-16

Apr-16

May-16

Jun-16

Jul-16

Aug-16

Sep-16

Oct-16

Nov-16

Dec-16

Jan-17

Feb-17

Mar-17

Code Blue

activated-

2015,16,17

14 10 17 12 7 4 9 18 14 23 22 16 13 16 13 15 20 21 13 14 12 17 13 19

Cardio Pulmon

ary Respirat

ory Arrest-2015,16

,17

9 7 10 6 5 1 4 12 7 21 14 11 11 14 7 12 9 15 9 7 12 11 11 15

Apr/15 May/15 Jun/15 Jul/15 Aug/15 Sep/15 Oct/15 Nov/15 Dec/15 Jan/16 Feb/16 Mar/16 Apr/16 May/16 Jun/16 Jul/16 Aug/16 Sep/16 Oct/16 Nov/16 Dec/16 Jan/17 Feb/17 Mar/170

5

10

15

20

25

14

10

17

12

7

4

9

18

14

23 22

16

13

16

1315 14

16

10

1412

14 13

16

97

10

6 5

1

4

12

7

21

14

11 11

14

7

12

9

15

9

13 12 11 11

15

Code blue activated vs Cardio pulmonary respiratory arrest -2015-17

Total no. of Code Blue activated-2015-17 Cardio Pulmonary Respiratory Arrest-2015-17

Training shows No. of code blues activated equal to CPR arrest from Sept-2016

13

Annexure-10

Code Blue team arrive within 3min(%)

 April May June July Aug Sept Oct Nov Dec Jan Feb Marc

hAverage (%)

2015-16 92.86% 100% 88.24% 100% 100% 50% 66.67% 100% 92.86% 82.61% 90.91% 87.50%

87.64%

2016-17 84.60% 81.25% 100% 86.67% 85% 93.75% 80.00% 100% 100% 100% 100% 94%92.89%

14

April May June July Aug Sept Oct Nov Dec Jan Feb March0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

120.00%

93%100%

88%

100% 100%

50%

67%

100%93%

83%91% 88%84.60% 81.25%

100.00%

86.67% 85.00%93.75%

80.00%

100.00% 100.00% 100.00% 100.00%93.75%

Code Blue- Team Arrive Within 3min(%)

2015-16 2016-17

Percentage

Average (% )2015-16 : 87.64%Average (% )2016-17 : 92%

Annexure-11

Return of spontaneous circulation (ROSC) after CPR (%)

  April May June July August September October November December January February MarchAverage (%)

2015-16 44.4% 42.9% 30.0% 33.3% 20.0% 0.0% 0.0% 33.3% 57.1% 33.3% 35.7% 54.5%

32.10%

15

2016-17 45.5% 50.0% 14.3% 41.7% 33.3% 46.7% 44.4% 30.8% 16.7% 36.4% 63.6% 40.0%

38.60%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

44.4% 42.9%

30.0%33.3%

20.0%

0.0% 0.0%

33.3%

57.1%

33.3%35.7%

54.5%45.5%

50.0%

14.3%

41.7%

33.3%

46.7% 44.4%

30.8%

16.7%

36.4%

63.6%

40.0%

Return of spontaneous circulation (ROSC) after CPR (%)

2015-16 2016-17

Average (% )2015-16 : 32.10%Average (% )2016-17 : 38.60%

Annexure12

Discharged after ROSC(%)

  Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb MarAverage (%)

2015-16 0.0% 14.3% 20.0%16.7% 0.0% 0.0% 50.0% 16.7% 14.3% 19.0% 14.3% 9.1%

14.50%

16

2016-17 27.3% 28.6% 57.1%16.7% 22.2% 40.0% 22.0% 15.4% 50.0% 36.4% 18.2% 33.3%

30.60%

Annexure-13a

Logistic Checklist -Code Blue Performa

2015/2016/2017

17

13 Was staff able to readily locate/operate the following:

Available, and was used

Available, but not used on the patient

Available, but defective

Not Available

a) Emergency Medicines

b) Defibrillator

c) Laryngoscope

d) Ambu bag

e) Oxygen Cylinder (filled or not)

f) Suction machine & suction catheter

g) Glucometer

Annexure-13b

18

Logistic Checklist Code Blue Performa 2015,2016,2017

  Ambu Bag

Laryngoscope & intubation Defibrillator ET tube &

AirwaysO2

therapy Emergency Medicines Others (

Non-compliance (%) 0.5 0.3 0.3 0.0 0.5 0.3 2.5 Compliance (%) 99.5 99.7 99.7 100.0 99.5 99.7 97.5

Ambu Bag Laryngoscope & intubation

Defibrillator ET tube & Airways O2 therapy Emergency Medicines

Others 0.0

10.020.030.040.050.060.070.080.090.0

100.0

1 2 3 4 5 6 71 2 3 4 5 6 7

0.5 0.3 0.3 0.0 0.5 0.3 2.5

99.5 99.7 99.7 100.0 99.5 99.7 97.5

Logistic Checklist Code Blue Performa 2015/2016/2017

Non-compliance (%) Compliance(%)

19