Mrs Jodie Pilkinton-Ching1
1Capital & Coast District Health Board, Wellington, New Zealand
A new model of cardiac arrest management has been developed where a nurse and doctor co-lead the team to effectively manage emergency department cardiac arrests. A research project was initially carried out in Wellington Emergency Department to identify if a simulation programme could provide effective training for senior nurses in a co-leadership model of cardiac arrest management. Nurse leadership was evaluated using a modified NOTECHs score. Improvement was shown in measures of leadership, adherence to NZRC algorithm, situational awareness and crisis resource management. This model has since been implemented in clinical practice.
A nursing leadership role in cardiac arrest management has been suggested as improving the efficiency of the emergency arrest team.
Wellington Emergency Department have developed and implemented a new model where a nurse and doctor co-lead the cardiac arrest team. The lead nurse is responsible for ensuring the resuscitation algorithm is followed, along with ensuring clear role allocation and effective CPR. This frees up the lead doctor to focus on identifying and treating the cause of the cardiac arrest.
A pre-intervention-post observational study was initially carried out in Wellington Emergency Department in 2018 to evaluate whether a interdisciplinary simulation programme could provide effective training in leadership skills for nurses carrying out this co-leadership role. A modified NOTECHS scale was used to score the nurse participants in five domains. Statistically significant improvement was noted for the measures of leadership, situational awareness, crisis resource management and adherence to the New Zealand Resuscitation Council algorithm.
An informal survey of nurses and doctors who participated in the study showed strong favour for the co-leadership model over the traditional doctor led model. Additional benefits were identified, including improved teamwork, nurses sense of empowerment and contribution in clinical leadership, increased confidence in communication and ‘speaking up’. Doctors reported the benefit of cognitive offload, being freed up to focus on diagnosing and treating the cause of the arrest without needing to also focus on the ALS algorithm. The learning gains of inter-disciplinary simulation followed by structured debriefs were also highlighted.
This co-leadership model of adult cardiac arrest management has since been developed and introduced in clinical practice in Wellington Emergency Department. EDAM events are evaluated and on-going simulation training is taking place to improve effectiveness.
Jodie Pilkinton-Ching is a Clinical Nurse Specialist in Wellington Emergency Department. She is part of a team who carried out a research project in 2018 evaluating the effectiveness of a simulation programme for improving nursing leadership skills in a new model of cardiac arrest management. This team has since introduced this model in ED clinical practice.