Improving Acute Care Nurses’ CPR Skills Retention, Knowledge and
Confidence Using AHA’s Resuscitation Quality Improvement (RQI) Program
Reggie Horwitz, MSN, RN-BC, APRN, AGCNS-BC, AGPCNP-BC, CCRN, CEN, CWCN, CWS, DAPWCA, FACCWS
Chatham University, Pittsburgh, Pennsylvania
Problem/PICO
Literature Review
Implementation Steps
 CPR skills and knowledge decay
occurs rapidly after initial training.
There is a clear need to have more
frequent reinforcement of CPR skills
(Meaney et al., 2013)
 Brief (2 minute) booster training sessions
at study entry, month one, month three,
and at six months produced effective
CPR skills retention (Sutton et al., 2011).
 Monthly skill practice w/ Heartcode BLS
VAM improved nursing students’
psychomotor skills & confidence
(Montgomery, Kardong-Edgren,
Oermann, & Odom-Maryon, 2012)
 Short and frequent training sessions
(every 3 months) were effective in
improving nurses’ retention of CPR
priorities (Sullivan et al., 2015).
 Deliberate practice is essential in skill
retention (Oermann et al., 2011; Sullivan
et al., 2015; Sutton et al., 2011; Wayne et
al., 2005).
1) Organize final pre-implementation
meeting with all stakeholders.
2) Tour units, share RQI handouts,
posters; present in-person or by PPT.
3) Pull BLS/ACLS compliance reports to
identify potential RQI participants.
4) BLS Program Director to email RQI
invite w/ instructions to nurses.
5) Respond to interested participants &
ask them to provide contact info.
6) Implement RQI after IRB approval,
consent signed & RQI assigned in TMS.
7) Facilitate RQI completions & use
survey tool on Weeks 1-2 and 7-8.
8) Collect, analyze data and evaluate RQI
project outcomes, share findings.
9) Complete capstone & manuscript.
Lack of confidence has been
identified as a consistent barrier to
achieving good quality CPR (Roh,
Issenberg & Chung, 2014).
PICO: “In acute care nurses (P), will
AHA’s Resuscitation Quality
Improvement (RQI) program (I) for
BLS and ACLS training improve
CPR skills retention, CPR
knowledge, & CPR confidence (O)?”
Improvement in:
1) CPR skills/performance;
2) CPR knowledge, &
3) CPR self- efficacy or confidence
using “CPR Skills Performance,
Knowledge and Confidence Survey”
Plan for Dissemination
 Leadership presentation
 Interprofessional hospital-wide &
nursing committees meeting
 VHA community of practice (COP)
 National and regional conferences
 Manuscript submission for journal
publication
Impact on Policy,
Use of Technology,
Interprofessional Collaboration
Background
There are an estimated 209, 000 inhospital cardiac arrests (IHCAs)
annually in US with 22.3% - 25.5%
survival rates (Kleinman et al., 2015;
Mozaffarian et al., 2015).
Large variations in survival rates for
IHCAs remain despite scientific
advances in cardiac arrest care.
Staff’s CPR performance contributed
to disparity (Girotra et al., 2014;
Perkins & Cooke, 2012). Several
studies have shown that CPR quality
is directly r/t survival outcomes. Poor
quality CPR considered preventable
harm (Meaney et al., 2013; Morrison
et al., 2013; Neumar et al., 2015).
Projected Outcomes
Traditional: high-dose, low frequency
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Theory or Model for EBP
Iowa Model of Evidence-Based
Practice (Revised 2015)
Rogers’ Diffusion of Innovation
Eriksson's Theory of Deliberate
Practice (low-dose, high frequency)
Project Timeline
January 2018-April 2018
 Weeks 1-8 (Steps 1-7 above)
 Weeks 9-14 (Steps 8-9 above)
 CPR Policy revision to add RQI into
AHA accepted course list
 This innovative CPR training is
technology-driven including
cognitive eLearning, voice advisory
manikin (VAM) & visual feedback
 Implementation, data collection &
analysis facilitated by technology
 Interprofessional implementation
team of leaders (nursing, medicine,
IT, engineering & support services)
References
 Available readily upon request.