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Welcome to another edition of the NLN Nursing EDge Unscripted podcast. I am your host today Dr. Kellie Bryant and I'm joined by our co-host Dr. Raquel Bertiz and we both work at the National League for Nursing. In this episode today, really excited about this episode, we're going to be discussing the Resuscitation Quality Improvement also known as RQI that is revolutionizing the way that we deliver CPR education. So for those of you that don't know about RQI, just a quick
introduction about RQI. It is a way to maintain CPR competencies. It is a digital and simulation-based training that delivers high realistic and lifelike scenarios that build confidence among its users and also competencies without the constraints of doing the traditional CPR training in the classroom. These are self-directed, science-based approach that allows providers to train on their own time and they spend more time with their
patient and less time in the classroom. It covers basic life support, pediatric advanced life support, and they also have advanced cardiovascular life support also known as ACLS. So it is backed by research. We have some research articles about RQI that we'll share links to at the end of this podcast. So to get us started, I'd love to introduce our guests today. First guest is Dr. Sarah Beebe and she is a simulation center program manager at Bay
Health Medical Center in Delaware. And we also have Dr. Donna Guerra who is currently the clinical associate professor in the College of Nursing at the University of Alabama in Huntsville. So warm welcome, thank you for being here with us today. Thank you. Thank you. So we're going to dive right in. First question - tell us a little bit about RQI and how you're using it at your institution. And I'll start with you Dr. Beebe. Yes, thanks. So I
work at a health care center in Delaware. We have two hospitals, two freestanding ERs and then also a number of urgent cares and outpatient clinics as well and we use RQI. We initially rolled it out just in the hospital setting, but now we have RQI carts or the device that the manikins and the computers sit on, we have them throughout the hospital, our freestanding emergency departments, and then one of our large urgent care and outpatient clinics as well.
And what about you Dr. Guerra? How are you using our RQI at your institution? So we are a college of nursing that offers from BSN, MSN ,to PhD and DNP. We do offer RQI as a means for BLS training for any of our nursing students who are interested in doing that or our faculty, but we require it in the traditional BSN track
of our undergraduate program. So a lot of schools, I know when I went to nursing school, you had to do your CPR training and kind of before you go to school, bring in a copy of your card, it was put into your record and you were good for two years, you know and I think a lot of places are still probably doing that same method. So what made your institutions decide to to try RQI and and track CPR in a different way? How did you come
to that decision? Since you brought that up about how we traditionally do that in nursing education, we did that as well. And in 2022 the NLN and Laerdal with RQI put out a call for colleges of nursing or other institutions that wanted to be early adopters of this technology with BLS. And we were one of 12 nursing programs nationwide selected to be change agents in nursing education in implementing RQI in our nursing programs.
And what about you Dr. Beebe? How did how did you come up... you're in a clinical setting, which is great. In academia but also clinical. Yeah, so a a big part of it was to get our staff back doing what they wanted to do, which was be at the bedside. Nobody wants to sit in a classroom on top of, you know, your usual workload and so that was a big driver for for us, not to mention the fact that you know RQI you're doing it quarterly so you
get to practice those skills quarterly. And you know, that's a big deal for a staff nurse or for a clinician who may not see codes on a regular basis or may not need their CPR skills very often. And so this gave them the opportunity to practice those skills over and over again, that kind of low dose, high frequency training and really it just made sense for our health
care system to do that. And we implemented RQI in 2017 so we were also kind of those early adopters of RQI and have been using it for quite a while. Yeah, I do have a question about your experiences and I just got interested with the word "change agent," and it seems like both of you and your organizations are early adopters and change agents. And therefore my question is so how did RQI change your organizations or your workflow?
So for us, I'll echo what Dr. Beebe said about that frequent, repeated practice, especially with those providers that may not be performing CPR on a regular basis, right. That's even more important in that frequent repeated practice in nursing students who are already novices with BLS, having that ability to do frequent, repeated practice is pivotal in those students gaining and maintaining competency of basic life support for us in the
health care setting. You know, a big change for us was the fact that we no longer need to offer all of these BLS courses that we once offered and our staff don't need to be taken, as I mentioned earlier, away from the bedside for a daylong course or a half day course or whatever it is. Even when we did you know all online and then you came in and did your skills it still took people off the units, it took them away from the bedside.
And you know, for us, we have carts throughout the organization so a lot of time we see nurses and other clinicians you know popping off their unit all day long going to one of the carts, doing their skills, and hopping right back into patient care, I mean literally feet from where they are taking care of their patients. So, you know, it was just such a huge change not to mention the fact that they now feel a lot more confident in at least
those basic CPR skills. Yeah, you brought up some good points because I think about for me, I was an OB so thank goodness I didn't have, I've never done CPR on an actual person, so I can imagine if I was to go and and practice CPR a year after getting my card my skills would have decayed. I'm sure I would not be doing my compressions correctly. So I love the idea of RQI doing that as you mentioned
high frequency, you know but low dose. So can you explain to us those of us that aren't familiar with RQI, what does that look like every quarter? Like what's being done, what's the amount of time that's needed to kind of do those quarterly checks? I'm happy to take this one. So we use a learning management system in the hospital just like you do in the academic setting. We typically use HealthStream but it pops up on our learning management system portal
quarterly. In fact, it feels more frequent at times, but pops up on our learning management system that we are due for our quarterly RQI and then there is a very short assessment on online on the computer that you do first or actually you can do it in any order. But you do an online component and then we go to one of the carts, sign in, into our account on our learning management system and then the computer is connected to the manikins and we do an adult and a newborn.
You know, we show our CPR skills little more advanced for, you know PALS and NRP and ACLS, but for the basic life support that's pretty much what it looks like, takes about 15-20 minutes no more than that and that's including the online portion.
The other important the other thing that I find interesting is that when we answer questions on the computer or do our skills it asks us how confident are you that you know the answer to like how confident are you that you know that you did it correctly even without the feedback. And I think that that's an interesting component to it because you know it can really show some of those differences in how we think we do and how we actually do, which is
cool. And one of the nice things, also once you do those quarterly checks it also extends your CPR certification by another three months so if you keep up with your quarterly assessments you'll actually keep on prolonging your certification, which I think is a great added bonus too. Yeah. I like that idea of not having to go through a lengthy time to just renew your CPR and with that, I would like to kind of like go back to some of the concepts that I've heard that two of you
say in terms of skills decay. And I think that was from Kellie and I think that's the rationale for the yes, you can extend your CPR renewal because then your skills have not declined or decayed. So the question that I would like to ask you now is like what did you observe from your learners in the academic settings and in the hospitals in terms of the skills. What do you measure those skills or what are the observable changes in your staff or personnel competencies?
I'll let Dr. Beebe discuss the clinical skills part of that. For us in our academic setting, it really changed the way we approached BLS as far as previously, our students we did require them to have BLS through the American Heart Association, so that part is the same, but it really has revolutionized the way that we approached that
by incorporating it into our curriculum. So the way that that we decided to implement that was to make it a clinical requirement of our first semester students in the upper division of
our program. During that semester, they have their first clinical course of health assessment and so we give them clinical time while they're here in the simulation lab to have time to do that initial test because we talked about the quarterly update, but we didn't really talk about the initial time commitment for gaining that initial competency before they go into
their into their quarterly. And the advantage to that is that while it is slightly longer than the quarterly time commitment, it's not much more than that. It's slightly longer for the online portion. It's slightly longer for the skills portion. But it's straightforward, to the point, and students are able to do that and still work that into their clinical time as they're becoming immersed into the nursing curricula, which is helpful to them.
They're already in the lab... It allows them to have access to faculty if they have any issues or need assistance with that initial certification or using the skills station, so it really has changed the the way we approach BLS in our curriculum. It is a part of our curriculum now rather than previously it was a requirement to attend. I love, I love that you just differentiated that that it used to be a requirement and now it's part
of our curriculum, which is so wonderful. In the health care setting, what we have found is that you know, we can then when we do get our learners in a room together, we can focus on higher level things. We can focus on team dynamics. We can focus on you know shocking with the defibrillator and what's a shockable rhythm and things like that instead of focusing all of our time on the BLS skills. And I will say that RQI does not replace
opportunities to practice as a team. You do it independently, yes, there are scenarios but until you are working as a team you know you still... it doesn't replace that part... but we have just rolled out mock codes that we run throughout
the entire organization. And what we found was you know, yeah, maybe the BLS skills need a little tweak here and there or something like that, but for the most part the BLS skills were down and then we could focus on you know improving shocking within the first two minutes, we could talk about more nuance things in a code that we may not have been able to do before, and you know that communication piece, the teamwork, all of that kind of stuff which we know is such a crucial part
to a successful resuscitation and so that's been you know our biggest outcome in our organization not to mention codes outside the, outside of the ICU are running more smoothly. And I believe part of that is due to RQI .Thank you for sharing that. So you bring up next question I want to ask you which is have you had any success stories from people who have taking taken the CPR using the RQI system? Any aha moments where it it really hit you
like oh, this training really does work? Do you have any of those stories to share? Yeah I do for sure.
You know, when nursing students are in clinical in our facilities if there is a code sometimes it becomes the students need to back away and let the clinicians who are there be the major participants in a code, and while that is still absolutely true, we did have a clinical group of a couple of students who went in to assess a patient during clinical they recognized that the patient was unresponsive
and was pulseless and they began CPR. There were some of their classmates right outside the door. They were able to alert the staff that there was an issue and then the students were doing a great job on CPR once the once the staff got into the room and so they allowed the students to continue doing chest compressions and after that was over
the patient went to the ICU. But later that week when they were in class the students instructor saw me in the hallway going to class and she stopped me called those students over and they were ecstatic that not only did they get that experience and they didn't have to leave the room but that they were able to intervene early and effectively and they were very confident about the skills that they had and they were so proud of themselves in knowing that they were giving
effective CPR. What a beautiful story because, like you said, so many times when students are in a clinical any emergency happens they're getting kicked out of the room so the fact that they the nurses came in and they saw them doing a wonderful job and said continue that. I could definitely see as boosting the students confidence and it had a good outcome. The person made it and went to the ICU hopefully they left the ICU. But thank you for
sharing that story. That was very impactful. I just got a story today actually. I was so excited. I was in a meeting and somebody shared a story that I was like, I'm gonna use this this afternoon! But Kellie, you and I are both women's health nurses by background, and yes, we did not practice CPR
on a regular basis. We knew how to do CPR on a baby, but not on an adult and so a colleague of mine, a bedside nurse here at our hospital, OB nurse ended up getting rear ended leaving the hospital a few months ago by a gentleman who was having a cardiac arrest at the wheel.
And so she hopped out and realized that he was in cardiac arrest and started, you know, called 911 but started CPR on him and she tried to get him out of the car but couldn't and so she did it right there in his seat in the car and and she did it until help arrived. He went to the hospital and actually she's being recognized in a couple of weeks by our EMS. Our county EMS system they do a ceremony for survivors and for the the people who saved them and so she gets to be honored at
that. She was telling us this story today but she attributed it to doing RQI because she said, "I'm an OB nurse we don't do CPR on adults very often." And if ever in our career and but she said but I knew from RQI what I was supposed to do and so I was able to do it and and save this person, which is just so cool. Beautiful! Another beautiful story! And perfect timing for our podcast. Yeah, exactly.
And those are amazing stories and to me, while listening to everything that you were saying, it's really about the patient outcomes in the end, right. Yes, we appreciate that our learners have knocked that down skills-wise so that they can move on to a higher level of thinking or decision making, but in the end, like it's really very gratifying to see that what we do, the innovations that we do as educators, are really impacting lives and patients. That's just amazing to hear.
Both of you I would call super users or champions of RQI. Is it a lot of manpower, a lot of work to get the system up and running and tracking all the learners? How much of your time does it take? From an academic standpoint I would say that it's somewhat minimal. We have a system administrator who inputs new learners, which for us, that's every semester. And so that probably takes most of the time, but the students are responsible for uploading certificates and that sort of thing.
For us, I am not the one that manages our RQI. We have a wonderful educator that does and we were chatting about it earlier today and she was saying the overall lift is not what it was when they were teaching classes non-stop. You still have to maintain manikins. You still have to maintain
the carts, make sure that they're operational. You know, the company is great about replacing skins and things like that, but just so people know there is maintenance involved and then also there's some backend work depending on what type
of learning management system you have. It's not always perfectly seamless from... RQI to learning management system, but what she said is that, you know, me working a little bit harder versus the satisfaction of our staff and the competency of our staff staff, you know, the the risk far outweighs the benefit or the benefit far outweighs the risk with that one. So yeah. There is some backend work to be done. But it's
well worth it, like you said. I mean, when it comes to patient safety and quality of CPR, you can't even put a number, you know, and measure that. But then on the other end, what you were saying is it in some ways could be less time consuming than you know, like I used to be a course coordinator of tracking down people, photocopying, uploading these CPR cards, and also I believe the system will send reminders too, automatically to the learners to let them know...
I'm due next or in a week and a couple of days. So I'm already getting my reminder that it's time. Well we're going to be getting our system in a couple weeks from Laerdal so we're really excited because it's perfect timing. My CPR's expired so I can't wait to use it firsthand myself. Any...I know we only have a couple minutes left but I just wanted to end with this last question.
For those out there, whether it's an academic institution or or a hospital medical center who are kind of thinking about incorporating RQI into their organizations, any tips or pearls of wisdom that you can give someone who may be thinking
about incorporating RQI? So I know one thing that when we rolled it out the staff were concerned about how much time it was going to take them because when you say quarterly when it's only been every two years, the immediate thought is taking the two-year course and applying it quarterly. And it is of course not that, but there can be push back initially. And so being able to share some of these success stories and explaining to to staff and you know what it's going to look
like for them. I know our hospital took the carts out to different units, to staff meetings, to things like that ahead of time so that they could see how easy it was going to be and that in the end it was going to save them time and improve their skills. And so there may be that concern about that push back, but there are ways of, you know, working around that. And I'll echo what Sarah said about
communication. From an academic standpoint, we make sure that we tell the students what to expect before we enroll them in RQI, because as Sarah said earlier, RQI is very, very good about sending reminders and reaching out to to students like it's an automatic response and so as soon as you enroll those students they will automatically get
an email. And if you have worked with students that are in that first semester where they're already overwhelmed with information, if they don't know to look for that, they can get confused and and kind of have a panic moment that they've forgotten something or didn't know about it. So just that clear communication with students about - you will receive an email about - and just preventing that confusion if you can. Wow, that 20 plus minutes went by so quickly! I just want to end
by thanking both of you. Thank you for sharing your experiences with RQI and hopefully our listeners out there learned a little bit more how the system can really improve patient outcomes by, like you had said, the frequent exposure and deliberate practice of CPR skills that can help prevent, you know, that decay that happens when you're kind of
going two years in between certification. So thank you so much for sharing all your your wisdom and giving some giving us some tips about the RQI system. Dr. Bertiz, I don't know if you have any last minute. Yes, I just would like to thank Sarah and Donna for really sharing your experiences and to me it's like concrete examples of what we
read in research. What we read, what we read about RQI and having the two of you actually give concrete examples of how it was operationalized and how you saw the outcomes, I really had great time learning about those. Thank you. And we'll make sure for all our listeners that we include links to some recent articles that have been published about RQI and also a link so that you can learn
more about the RQI system. Thank you everyone for joining us and we'll see you on our next podcast. [Music]