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Automated External Defibrillation (AED) led by registered nurses (Policy base)

-Previous Practice   – use of AED but icu nurses not allowed  to use 

-New Practice- allowed to use AED by nures to give first shock

 -Additional Considerations 

-Evidence Based Benefits 

-Obstacles 

Conclusion

Previous practice

 Upon finding an unconscious patient, responsiveness and pulse will be checked.

– No response, no pulse, activate Code Blue – Commence CPR -Perform CPR until doctor arrives –This could lead to a few minutes delay in defibrillation

Shockable Rhythms - 

1)Pulseless Ventricular Tachycardia Very rapid but ineffective contractions, leading to insufficient organ perfusion and heart failure Rhythm: Regular/Irregular Rate: >100 bpm P Wave: Absent QRS Complex: Wide and bizarre 

 2)Ventricular Fibrillation Fibrillating heart that does not produce a pulse or adequate cardiac output due to multiple ectopic electrical impulses that depolarize the myocardium in a chaotic fashion Rhythm: Irregular Rate: 250-250 bpm P Wave: Absent QRS Complex: Unmeasurable …..reference latest

 Importance of Early Defibrillation – Electrical defibrillation provides the single most important therapy for the treatment of ventricular fibrillation (VF) or pulseless ventricular tachycardia (referencessss latest)

Some points to support with referene/ literature latest fromm 2015 to 2022 at least 5.

Electrical defibrillation provides the single most important therapy for the treatment of ventricular fibrillation (VF) or pulseless ventricular tachycardia (reference)

 Survival rates are highest when defibrillation is delivered within 3 minutes of the time of collapse (Perkins et al., 2015). 

Chance of survival decreases 7%-10% as each minute passes (reference)

New practice 

Nurses role:  Push E trolley and Defibrillator, Put in CPR board and AED pads , Switch on Defibrillator to ‘AED Mode’ , Follow AED voice prompt , Deploy AED shock safely as advised.

Can take role of nurse 2 from policy who can give shock

AED Function to  Analyze the electric rhythm of the heart.  Determine whether electrical rhythm needs to be shocked.  If a shock is required it automatically charges to a pre-set energy level. If no shock is required, the device will not charge. Deliver electric shocks via attached AED pads.  Advise the rescuer, through voice prompts, on key actions to deliver the shock, check the casualty or continue CPR.

Action and consideration

Ensure no metal, water, gas (flammable) on patient or surroundings* Water and metal are electricity conductors and may endanger the patient/healthcare worker. Flammable gas pose as fire hazards. 

Skin preparation:* Shave any chest hair (if any) Ensure skin is clean and dry For better skin contact, so that rhythm can be analyzed and shocks and be delivered properly 

Proper placement of defibrillation pads* Effective pad placement ensures that a shock is delivered on an axis through the heart. 

To check the heart rhythm right before delivering the shock to patient To ensure shock is being delivered to the right rhythm as the rhythm may have changed 

To shout ‘Stand Clear’ before delivering the shock to patient To alert everyone else to stay clear of the patient and bed to prevent them from being shocked as well

All these steps to be done with no/minimal interruption to CPR

Evidence Based Benefits 

 In a study done by ……………………in an ICU setting, defibrillation that occurs 3 minutes .

In a hospital that changed from manual defibrillators to automated defibrillators, survival of all patients with resuscitation events improved 2.6-fold, from 4.9% to 12.8%. This result is purely due to patients with VT/VF that survived ……………………….. reference

In the General Ward, nurses applied and activated the AEDs before the cardiac arrest team arrived in 81.8% of the cases. The median time from onset of the emergency call/activation to activating the AED was 2.1 minutes, whereas the median arrival time for the cardiac arrest team was 4.7 minutes. Out of the patients who had Return of Spontaneous Circulation (ROSC), those that received early defibrillation had a discharge-to-home rate of 88.9% vs 55.6% for those who received defibrillation later 2 ( all with reference)

 

Obstacles Reluctance of nurses to embrace the role of defibrillation due to; 

 Lack of confidence 

 Fear of incurring litigation/Harming the patient or themselves With  reference 

 

Perceived difficulty in interpreting shockable rhythms With  reference 

 

Perception that defibrillation is a medical responsibility With  reference 

 

Poor knowledge and skill retention following BCLS+AED training for nurses With  reference 

Conclusion

 Nurses are usually the first responders to a collapsed patient, therefore it would be beneficial to train and allow nurses to use the AEDs to deliver early defibrillation to increase the patient’s chances of survival. However it would be important to first change nurses perception to enable them to open up to the change.

 

kindly write in academic essay of  700 words. thank you

 

SCIENCE
HEALTH SCIENCE
NURSING
NURSING HSAF20

 

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