CPR for Family Members and Caregivers of At-Risk Patients
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Transcript of CPR for Family Members and Caregivers of At-Risk Patients
Identifying and Overcoming Barriers to CPR Education in Family Members and Caregivers of at Risk Patients
Judy Vierke, RN, MS, CCNSManager of Education & Prevention
Edward Heart Hospital
David Hiltz, NREMT-PAmerican Heart Association
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Conflict of Interest DisclosureVierke
• Commercial/industry– No Conflicts to disclose
• Potential intellectual conflicts– No Conflicts to disclose
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Conflict of Interest DisclosureHiltz
• Commercial/industry– Full-time employment by the American Heart
Association
• Potential intellectual conflicts– Full-time employment by the American Heart
Association
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Objectives• Identify perceptions and barriers that impact family members of
high-risk cardiac patients from learning cardiopulmonary resuscitation (CPR).
• Discuss how to implement a program that will assist physicians in recommending CPR training for high-risk family members.
• Describe innovative teaching modalities available for reaching community participants with different learning styles and need to increase the number of trained participants available within a community.
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Facts
• 335,000 Sudden Cardiac Arrests (SCA)
• 163,221 out-of-hospital SCA
• 80 % SCA occur in or near home
• Spouse or family members most likely to witness
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LiteratureFamily members of high-risk populations:• Benefit from learning CPR• Learn CPR successfully without deleterious
psychosocial consequences• Not likely to seek CPR training• Least likely to actually receive CPR training
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Alternative methods
must be developed
to market CPR training
to these groups!
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No CPR Information!
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Hear no evil, see no evil, speak no evil!
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Case For Support
G2000 (IIa)
• Families and caregivers of: – infants and children at risk– adults at risk
G2005
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Charges!
Additional studies are needed(1) To confirm what type of courses lead to
increased participation in CPR training(2) Describe factors that prevent healthcare
professionals from recommending CPR training to families of at-risk patients
(3) Identify CPR training methods that are most attractive to families and caregivers of at-risk patients
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Edward Heart Hospital
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Institutional CultureProgressive Heart Hospital• Focus on Patient, Family and Staff Education &
Prevention• Alliance with American Heart Association (AHA)• AHA Training Center• Presence in Community for Cardiac Education &
Prevention, CPR & AEDs
• Resistance to discussing CPR with families
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Research Questionnaire
• Institutional Review Board (IRB)
• Patient Survey
• Family Member Survey
• Physician / Advanced Practice Nurse (APN) Survey
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Patient Surveys
• Distributed through Cardiac Rehab
• 31 surveys returned
• Mean age 65
• 68 % male
• 81 % lived with family / friends
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Patient Survey
• 94 % think that knowing CPR is important for family members of people with heart disease
• 97 % would encourage their family members to learn CPR
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Patient Survey
• 53 % would have liked a healthcare professional to have discussed options of CPR with their family
• Only 30 % of the time did a healthcare professional discuss / recommend CPR training with family
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Patients want us to discuss CPR more with their families!
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Family Survey
• 24 surveys returned – 7 patients lived alone
• Mean age 59• 73 % would have liked a healthcare
professional to discuss CPR options• Only 21 % stated a healthcare
professional discussed CPR
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Family Survey
• 95 % think CPR is important for family members of people with heart disease
• 86 % felt they are able to acquire knowledge and physically capable of learning CPR
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Family Survey
• 50 % had prior training in CPR– 82 % greater than 2 yrs ago– 91 % had no training in AEDs
• Only 24 % felt “somewhat confident” in their CPR skills
• 76 % “unconfident” in skills
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Family Survey
• Reasons for not taking CPR– 50 % never thought of it *– 33 % not a priority *– 8 % lack of information *– 8 % anxiety *
* Healthcare Professionals can assist in overcoming these barriers
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Family Survey – Likely to Take CPR If …
• 87 % Info available
• 91 % Health professional / Physician
recommend
• 100 % No written test
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Family Survey
• What is the ideal class style / learning model?– 50 / 50 split– Traditional instructor class vs. home self study– No statistical difference
• age or educational level
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• Families want us to discuss CPR with them
• Families are uncomfortable with their CPR skills
• We can impact number of families becoming trained
Key Points:
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Physician / Advance Practice Nurse (APN) Survey• 26 Surveys • Mean age 43• 31 % Internal medicine• 19 % Cardiology• 15 % Family Practice • 15 % APN• 19 % Other
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Physician / APN Survey
• 35 % both BLS & ACLS
• 23 % BLS
• 8 % ACLS
• 19 % have performed CPR out of the hospital setting
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Physician / APN Survey
Routinely Counsel on:
• 100 % Risk factor modification
• 81 % Warning signs of heart attack
• 73 % Importance of calling 911
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Physician / APN Survey
Reasons for not recommending CPR
• 54 % Lack of information on classes
• 50 % Never thought of it
• 27 % No time
• 12 % Concerns of anxiety
• No one felt it was inappropriate
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Name: ___________________________Date: __________
Education Prescription ___ Cardiac Rehab/Exercise Call 630-527-3388___ Diabetes Education Call 630-527-3213___ Heart Coach Call 630-527-2825___ Metabolic Syndrome / Weight Loss Program Call 630-527-2825___ Cardiovascular Screenings For Loved Ones Call 630-527-2825 ___ Ultrafast Heart Scan ___ Stroke & Vascular Screening ___ Cholesterol Screening ___ Stress Workshop ___ Delicious Meets Nutritious ___ Blood Pressure Workshop ___ Smoking Cessation___ Cholesterol Workshop ___ CPR for Loved Ones Call 630-527-6363 for dates, fees, and registration. Signature: ______________________________, M.D./R.N.
additional information on back
100 % Physician / APN Supportive of CPR Script
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Next Steps
• Adding CPR to our education prescription• Monitor enrollments to CPR classes from
education prescription• Re-survey physician / APN for changes in
practice• Investigate & implement CPR Anytime
program with inpatients & physician offices
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Vision
• Create and implement an initiative that will increase enrollment in the CPR courses and help to improve the health of our community
• Promote the important messages about cardiac emergencies and CPR
• Improve cardiac arrest survival rates by increasing the number trained in bystander CPR
• Create a program that provides an excellent example of how to work with physicians for a healthier community
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A Physician CPR Prescription Program
provides a mechanism for physicians to:
• advocate for CPR training
• increase the number of family members of at-risk patients who recognize the signs of an emergency, know when to phone 911, and know how to perform cardiopulmonary resuscitation (CPR).
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Case for Support!
• Most cardiac arrests occur
in and around the home
• At-risk population is
underserved
• Power of physician influence
is well established
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How it Works
• Physicians agree to be a part of the Physician CPR Prescription Program
• Participating physicians are provided with a description of the Physician CPR Prescription Program and pre-printed CPR prescription pads
• The patient and/or a family member calls the predetermined contact information for CPR courses being offered and enrolls in a CPR for Family and Friends course
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Rx pad is preprinted with the Rx pad is preprinted with the physician group logo and the physician group logo and the
information needed to locate an AHA information needed to locate an AHA CPR course.CPR course.
Anytown Cardiology Associates
555 Main Street
Anytown, USA 55555
NAME AGE
ADDRESS DATE
SIGNATURE Dispense as Written
No Substitutions
American Heart Association
CPR for Family and Friends Course
Call 1-877-AHA-4CPR to Enroll Now
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““Quick Facts” preprinted on backside Quick Facts” preprinted on backside of Rx to assist physician in delivering of Rx to assist physician in delivering
the persuasive CPR message to the persuasive CPR message to patients and their families.patients and their families.
70 – 80% of the cases that require CPR occur in and around the home – so it is going to be up to each one of us to save our loved ones.
The best time to learn CPR was yesterday –tomorrow may be too late.
CPR is easy to learn do it today!
CUSTOM MESSAGE HERE
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Theoretical Example
• 10 physicians participate
• Each physician provides 100 CPR course referrals over 1 year
• 400 – 600 learn early
warning signs and
how to perform CPR
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Changes
EVERYTHING!
™ CPR Anytime
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What Changes?
• More barriers removed
• Increased efficiency
• Easier to fund/sponsor
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Small Pilots in Rhode Island
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Pilots
South County Cardiology Associates and
Cardiovascular Associates of RI
• Buy-in from senior associates
• MD RX methods
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Pilot Goals
• “Gut check” – see if it works!
• Further validation of theory
• Ramp-up for larger study
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Pilot Results
• It works!
• Theory validated
• Implementers excited!
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Endorsement
Partner opportunities!
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• Additional experience will identify an effective means to prompt enrollment in CPR courses
• Additional work is also needed to determine the overall effectiveness of the initiative
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• Further investigation can lead to a method for overcoming factors that prevent healthcare professionals from recommending CPR training to families of at-risk patients.
• This work will also identify the methods that make CPR training attractive to families and caretakers of at-risk patients.
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Materials Created
• PowerPoint
• Guide
• Templates
• Marketing Collateral
• Press Release
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Summary
We can impact lives saved!
• Patients & families want us to discuss CPR • Families are uncomfortable with their CPR skills• We can overcome barriers• We can impact number of families trained• Alternative innovative options need to be explored• CPR Prescription & CPR Anytime have a role
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Questions
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Judy Vierke, RN, MS, CCNSManager of Education & Prevention Edward Heart [email protected]
David Hiltz, NREMT-PSenior Regional ManagerAmerican Heart [email protected]
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ReferencesGuidelines 2000 for Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care: International Consensus on Science. Circulation. 2000;102(suppl I):I-8
Guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC). JAMA. 1992;286:2135-2302
Chu KH, May CR, Clark MJ, Breeze KM. CPR training in households of patients with chest pain. Resuscitation. 2003;57:257-268.
Dracup K, Moser DK, Taylor SE, Guzy PM. The psychological consequences of cardiopulmonary resuscitation training for family members of at risk for sudden death. Am J Public Health. 1997;87:1434-1439
Dracup K, Moser DK, Taylor SE, Guzy PM, Marsden C. Is cardiopulmonary resuscitation training deleterious to family members of at risk patients? Am J Public Health. 1994;84:116-118
Dracup K, Heany DM, Taylor SE, Guzy PM, Breu C. Can family members of high-risk patients learn cardiopulmonary resuscitation? Arch Intern Med. 1989;149:61-64
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ReferencesGoldberg RJ, Gore JM, Love DG, Ockene JK, Dalen JE. Layperson
CPR – Are we training the right people? Annals of Emergency Medicine. 1984; 13:9:89-92.
Goldberg RJ, DeCosimo D, St. Louis P, Gori JM, Ockene JK, Dalen JE. Physicians’ attitudes and practices toward CPR training in family members of patients with coronary heart disease. AJPH. 1985;75:281-283.
Platz E, Scheatzle MD. Pepe PE, Dearwater SR. Attitudes towards CPR training and performance in family members of patients with heart disease. Resuscitation. 2000.;47:273-280.
http://www.ajph.org/cgi/content/abstract/87/9/1434
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Thank You!