Children's Hospitals Today - Fall 2022 - 5

FROM EXPERIENCE / ROUNDS
successful implementation
of the bundle. " The belief
persists that IHCA is an inevitability
of critical illness, but
as early adopters of
the bundle overcame
obstacles and shared
their improvement
learnings on these
webinars, th i s
dogma was challenged.
Confidence
steadily increased among
once reluctant participants
that IHCA is indeed preventable, "
says Alten. " Proving
feasibility of IHCA prevention
represents the most
essential message of this
project. Hopefully it will
encourage spread of these
IHCA prevention practices
at other hospitals. "
The team analyzed data
from 41,204 admissions,
including
10,510 admisfewer
in-hospital
cardiac arrest
events per month.
sions at participating
hospitals, with
2 ,664 of admissions
receiving
the bundle for an
average of 4.4 days
per patient. For all
admissions, there
was a 30% relative
reduction in IHCA incidence
rate during the intervention
period, which translated to
an average of 11 fewer IHCA
events per month.
Medical City Children's
Hospital in Dallas, which participated
in the collaborative,
reduced its cardiac arrest rate
by 49% using the bundle. " Our
results demonstrate that
identification of high-risk cardiac
populations is possible,
and a simple bedside cardiac
arrest prevention bundle can
result in significant reduction
of cardiac arrest, " says
Tia Raymond, M.D., pediatric
cardiologist at Medical
City Children's.
NEXT STEPS
Researchers in the study
say this represents an
important paradigm shift
in critical care to prioritize
IHCA prevention and reduce
adverse events. " The best
CPR is no CPR, " says Alten.
" And this project was able to
prevent CPR in almost 200
high-risk children during
bundle implementation at
these 15 hospitals. "
Future studies are needed
to determine which bundle
elements are most necessary
for cardiac arrest prevention.
More work is needed
to roll out the care bundle
to more hospitals. Although
the details of interventions
vary, the team leaders
say the core elements of
this bundle can likely be
adapted to other critically ill
populations, such as general
pediatric and adult intensive
care patients, and adult cardiovascular
ICUs.
Bo McMillan, APR, is a senior
associate, Public Relations,
at Cincinnati Children's
Hospital Medical Center.
Tell your hospital's story. Email
magazine@childrenshospitals.org.
Cardiac Arrest Prevention Bundle
SAFETY HUDDLE
This formal bedside
discussion occurs
separately from patient
rounds and is designed
to create situational
awareness for high-risk
patients. The twice-daily
huddle includes a bedside
nurse, nurse leader,
attending physician,
first-responding provider
and respiratory therapist.
Topics must include the
most likely reason for an
IHCA as well as mitigation
and rescue plans.
VITAL SIGN DISCUSSION
This discussion can
occur during the huddle
and seeks to establish
parameters for patientspecific
vital sign
targets, defining changes
that may represent
early deterioration.
These parameters are
posted in the patient's
room, programmed
into the monitor,
and require bedside
clinician evaluation and
reassessment if there
are changes.
PRE-SEDATION
DISCUSSION
This element also
occurs during the
huddle. The team
discusses the use
of pre-sedation for
harmful stimuli
since patients in
weak condition
are more likely
to suffer sudden,
adverse changes
because of
agitation or pain.
EMERGENCY
MEDICATION
Since many IHCA
episodes are
preceded by acute
hypotension, rapid
administration of
epinephrine may
rescue a patient
prior to cardiac
arrest. The bundle
calls for patientspecific
doses
to be pre-drawn
and stored at
the bedside.
FORMAL CODE
REVIEW
All cardiac arrests
must be reviewed
within two weeks
of the event-and
ideally within 48
hours. Clinical staff
involved in the event
should be present
during the review,
and key learnings
and improvement
opportunities should
be disseminated to the
rest of the medical and
nursing staff.
CHILDREN'S HOSPITALS TODAY Fall 2022
5
Children's Hospitals Today - Fall 2022

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