{"id":15106,"date":"2018-03-27T09:30:37","date_gmt":"2018-03-27T15:30:37","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=15106"},"modified":"2021-03-31T10:50:44","modified_gmt":"2021-03-31T16:50:44","slug":"lives-saved-by-empowering-nurses","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/lives-saved-by-empowering-nurses\/","title":{"rendered":"Lives saved by empowering nurses"},"content":{"rendered":"
<\/div>
\"A
UCHealth nurses train on the new protocols for cardiac arrest in heart surgery patients using simulators.<\/figcaption><\/figure>\n

Now able to intervene within seconds, intensive care nurses at UCHealth are preventing more cardiac arrests in heart surgery patients.<\/p>\n

What\u2019s the contributing factor?<\/p>\n

UCHealth Medical Center of the Rockies\u2019 adoption of<\/a> Cardiac Surgery Unit-Advanced Life Support (CSU-ALS) protocol, which was only recently published and accepted in the United States.<\/p>\n

\u201cCSU-ALS enables nurses to administer a targeted treatment quicker,\u201d said Melanie Roberts, a clinical nurse specialist for critical care at MCR. \u201cNurses are doing the right thing in seconds for the best outcomes.\u201d<\/p>\n

Work earns Magnet Nurse of the Year<\/h2>\n
\"A
Melanie Roberts was awarded 2017 National Magnet Nurse of the Year in empirical outcomes by the American Nurses Credentialing Center for her work in implementing CSU-ALS at UCHealth.<\/figcaption><\/figure>\n

In October 2017, Roberts was awarded 2017 National Magnet Nurse of the Year in empirical outcomes by the American Nurses Credentialing Center for her work in implementing CSU-ALS at UCHealth.<\/p>\n

\u201cThis protocol and redesigned workflow allows nurses to take action within the 15 to 20 seconds that will prevent cardiac arrest in these patients,\u201d she said.<\/p>\n

Traditional life support methods (Advanced Cardiac Life Support or ACLS<\/a>) \u2014 usually begin with chest compressions \u2014 don\u2019t make sense for cardiac surgery patients, who are in an ICU where other life-saving interventions are immediately available.<\/p>\n

These interventions, such as a pacemakers and defibrillators, may prevent the need for CPR and, in many cases, stop a full cardiac arrest from occurring, Roberts added.<\/p>\n

In 2015, the year prior to CSU-ALS implementation at MCR, 73 percent of cardiac surgical patients who required resuscitation in the cardiac ICU needed chest compressions, whereas in 2016, the year after CSU-ALS became protocol, only 32 percent needed chest compressions, according to MCR data.<\/p>\n

It\u2019s evident that early intervention is key, Roberts said.<\/p>\n

Then and now<\/h2>\n

Before the protocol, a patient who showed signs of cardiac arrest received CPR from a nurse until the pacemaker or defibrillator arrived.\u00a0 Now CSU-ALS gives nurses the tools and training to intervene immediately before the doctor gets there. The CSU-ALS protocol has unique interventions and calls on a special \u201ccardiac surgery code team.\u201d Measures include using temporary pacing wires or already-attached defibrillation pads, employing different standards for CPR depth, and even opening up the chest to get to the heart.<\/p>\n

\u201cWe have to intervene immediately if we are going to prevent cardiac arrest,\u201d Roberts said.<\/p>\n

In the first year the CSU-ALS protocol was implemented, the percentage of patients who went into cardiac arrest decreased from 2.67 to 1.6 percent.<\/p>\n

\"A
With the new protocol, patients are prepped, as seen on this patient’s chest, for a cardiac incident so live-saving actions can be taken within seconds of an arrest.<\/figcaption><\/figure>\n

\u201cNow nurses hook the patient up to a pacemaker and have defibrillators outside the room to use to restore the heart rhythm faster,\u201d Roberts said. \u201cChest compressions help get a pulse back, but we don\u2019t want to use chest compressions if we don\u2019t have to.\u201d<\/p>\n

Patients who have undergone complex cardiac surgical procedures, such as open-heart surgery, have unique hemodynamics, she said. Compressions from CPR can cause serious issues, and ACLS-recommended medication has the potential to cause bleeding in these patients. ACLS guidelines don\u2019t address this specific group, but CSU-ALS does.<\/p>\n

CSU-ALS was developed in Europe in 2009 and approved by the European Resuscitation Council. But it was only recently that the Society of Thoracic Surgeons in the United States endorsed the guidelines.<\/p>\n

Roberts presented CSU-ALS and UCHealth\u2019s findings at the 2017 ANCC<\/a> National Magnet Conference in Houston, Texas, in October. The Magnet Recognition Program, and its hospital designation, is a leading indicator of an organization focused on quality patient care, nursing excellence and innovations in professional nursing practice, according to its website. Its national conference is attended by more than 9,000 nurses and nursing executives, representing more than 20 countries.<\/p>\n

\u201cMany asked how I was able to do it here when the protocol was so new to the U.S. and such a complex practice change,\u201d Roberts said.<\/p>\n

Roberts shared her strategies, which included help from Susan Miller, a cardiovascular surgery nurse practitioner at MCR.<\/p>\n

Roberts and Miller introduced the protocol to MCR management in 2014, presenting research that validated benefits for patients. They soon received the support of cardiothoracic surgeons, quality and code committees and senior leadership. Both nurses attended a CSU-ALS conference in 2014 and instructor training in 2015, becoming two of the first health care professionals in the United States certified to train others in CSU-ALS.<\/p>\n

Then in 2016, Miller and Roberts trained more than 60 nurses and other members of the ICU cardiac team in CSU-ALS, and held monthly mock trainings to keep their skills sharp.<\/p>\n

\u201cNurses embraced this new protocol once they proved to themselves they could do it,\u201d Roberts said. \u201cThere is a strong positive reinforcement with CSU-ALS because when it\u2019s needed, they see right away that it works.\u201d<\/p>\n

Roberts and her team continue to track and record data on CSU-ALS because there is limited published data on its use in the U.S., she said. She said UCHealth plans to implement it system-wide.<\/p>\n

Roberts hopes that her recent recognition by Magnet will add momentum to CSU-ALS implementations, not only at UCHealth but across the country.<\/p>\n

\u201cWe work really hard to be a Magnet-designated hospital,\u201d Roberts said. \u201cAnd it pushes us to do these types of projects and implement these innovative practices that empower our nurses and benefit our patients.\u201d<\/p>\n

Along with MCR, UCHealth Poudre Valley Hospital and UCHealth University of Colorado Hospital are Magnet-designated hospitals.<\/p>\n","protected":false},"excerpt":{"rendered":"

Now able to intervene within seconds, intensive care nurses at UCHealth are preventing more cardiac arrests in heart surgery patients. What\u2019s the contributing factor? UCHealth Medical Center of the Rockies\u2019 adoption of Cardiac Surgery Unit-Advanced Life Support (CSU-ALS) protocol, which was only recently published and accepted in the United States. \u201cCSU-ALS enables nurses to administer […]<\/p>\n","protected":false},"author":2164,"featured_media":15108,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[8],"tags":[3512,82,3300,3317,702],"class_list":["post-15106","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-news","tag-heart-and-vascular-care-cardiovascular","tag-heart-and-vascular-care-cardiology","tag-heart-surgery-treatments","tag-magnet-recognition-program","tag-surgical-care"],"acf":[],"yoast_head":"\nEmpowering nurses: 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When she's not writing, Kati is creating her own stories with her husband Joel and their two children.","url":"https:\/\/www.uchealth.org\/today\/author\/katieblocker\/"}]}},"coauthors":[{"id":2164,"name":"Kati Blocker","link":"https:\/\/www.uchealth.org\/today\/author\/katieblocker\/"}],"_links":{"self":[{"href":"https:\/\/www.uchealth.org\/today\/wp-json\/wp\/v2\/posts\/15106","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.uchealth.org\/today\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.uchealth.org\/today\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.uchealth.org\/today\/wp-json\/wp\/v2\/users\/2164"}],"replies":[{"embeddable":true,"href":"https:\/\/www.uchealth.org\/today\/wp-json\/wp\/v2\/comments?post=15106"}],"version-history":[{"count":10,"href":"https:\/\/www.uchealth.org\/today\/wp-json\/wp\/v2\/posts\/15106\/revisions"}],"predecessor-version":[{"id":35045,"href":"https:\/\/www.uchealth.org\/today\/wp-json\/wp\/v2\/posts\/15106\/revisions\/35045"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.uchealth.org\/today\/wp-json\/wp\/v2\/media\/15108"}],"wp:attachment":[{"href":"https:\/\/www.uchealth.org\/today\/wp-json\/wp\/v2\/media?parent=15106"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.uchealth.org\/today\/wp-json\/wp\/v2\/categories?post=15106"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.uchealth.org\/today\/wp-json\/wp\/v2\/tags?post=15106"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}