Leading Disruptive Innovations toImprove Resuscitation Outcomes

Alex Klacman, MSN, Ed., RN, CCRN

June Marshall, DNP, RN, NEA-BC

TONE Conference

February 5, 2016

Objectives

• Explain factors that impact CPR competency

development and maintenance.

• Build a rationale and business case for nurse

executives’ deployment of an innovation.

• Identify key outcomes and benefits of RQI™

program implementation.

Disruptive Innovation

• Transforms by “introducing simplicity, convenience,

accessibility, affordability where complication and high

cost are the status quo.”

• Disruption is a positive force.

• Disruptive innovations make products and services

more accessible and affordable.

(Christensen, 2015)

Building a Case for Disruptive Innovation

• Poor-quality CPR leads to poor patient outcomes creating a “preventable harm” to the patient

• There remains an unacceptable disparity in the quality of resuscitation care delivered, as well as, the presence of significant opportunities to save more lives

(AHA 2013 Consensus Statement: CPR

Quality)

Resuscitation Education: Current State and Future State

Traditional Classroom-Based Training Model

High dose/Low Frequency Maintenance of CPR certification

Greater than $500,000

No ongoing maintenance of CPR competencies

Resuscitation Quality Improvement (RQI)™

High frequency/Low Dose Maintenance of CPR Competence

Savings of over $250,000/year

On-going maintenance of CPR competencies

“CPR self-instruction through video- and/or computer-based modules paired with

hands-on practice may be a reasonable alternative to instructor-led courses”

AHA, 2015 Guidelines for CPR and Emergency Cardiovascular Care

Disruptive Innovation: RQI™ Program

Innovation Diffusion

• Getting a new idea

adopted, even when it

has obvious

advantages, is difficult.

• Innovation diffusion –

either planned or

spontaneous

(Rogers, 2003)

Main Elements of Innovation Diffusion

1. The Innovation

2. Communication Channels

3. Time

4. The Social System

(Rogers, 2003)

Implementation of Disruptive Technology

• Pre-Implementation… building the business case and plan

• Implementation…gaining acceptance and compliance

• Post-Implementation… improving patient outcomes and provider competence and confidence

Competence: Definition

• The ability of a nurse to effectively demonstrate a set

of attributes, such as personal characteristics, values,

attitudes, knowledge and skills, which are required to

fulfil his/her professional responsibility. (Takase et al.,

2011)

• It is the exhibition of this competence that enables a

nurse to provide safe and effective patient care. (Axley,

2008; Valloze, 2009)

Competency Models

• Benner’s Novice to Expert –

knowledge and reflective time

within the power of experience.

(Benner, 2001; Lyneham et al.,

2009)

• The Donna Wright

“Competency Assessment”

Model – fluid, ongoing

process….dynamic and

responsive to the changing

environment. (Wright, 2005)

Donna Wright’s Competency Model

• Incorporates Adult Learning Principles

• Multiple Methods of Competency Verification

• Self-directed – Personal Accountability

• Flexibility

• Educator as Facilitator and Resource

• Emphasis on Performance Outcomes

(Wright, 2005)

RQI™ Program: A Model for Maintenance of Competence

RQI™ Analytics: Supporting Competence Development

RQI™ Analytics: Supporting Competence

Texas Health Dallas Outcomes

Provider Perspectives

“Initially my thoughts were that it would be nice not having to sit for hours in a

classroom to renew my CPR. It will also be nice to practice in a private setting

where I can practice at my own pace. I was hesitant about the frequency of the

RQI check-off”

“My thoughts now are that the RQI is a simple refresher to keep my skills in

check. It does take a few ‘trial and error” runs before you become accustomed to

the different options for assessment and intervention, but the main benefit is the

constant refresher and knowledge check; it’s easy to forget something as simple

as compression depth or frequency of ventilation in an arrest. It is the perfect

amount of time to complete your requirements at your own pace”

Competence & Confidence

“An infant presented in arrest and I was assigned the role of compressions. I had never performed CPR on an infant before. However given the training we recently received, and having used the RQI as part of that training, I felt very comfortable in my role. I was able to remain calm keep my compression rate and depth controlled along with making sure there was good chest recoil, skills that I was taught through the use of the RQI…in closing, I whole-heartedly believe that RQI is one of the best training tools that we as healthcare professionals have. I believe that its’ use aided me in being able to perform excellent compressionsgiving this infant the best possible outcome. I am so privileged to be a part of the first healthcare system to have this amazing tool that I believe will lead to better outcomes for patients, and highly recommend the use of RQI as part of the training for any future resuscitation”

Value of Super Users

“Our RQI super user has been a great support- she watches the lists and helps staff complete whatever is needed. She is an excellent resource and has been a fantastic super user. The amazing part– she does this in her 3 days/week here!”

“Our super user is an excellent resource for the staff. She assists staff with the equipment as needed and provides reminders when deadlines are approaching. Our unit stays up to date and maintains 100% compliance because of her leadership.”

“The super-user for our department has done a fabulous job. She makes sure the equipment is in working order and helps others when necessary. Since our unit houses one of the RQI stations she often assists others from across the hospital, as well. She has helped us maintain 100% compliance in our unit. I’m very thankful for her leadership. “

Questions and Answers

References

• American Heart Association. (2015). 2015 American Heart Association guidelines update for

cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 132(18), 313-

589. doi:10.1161/CIR.0000000000000268

• Axley, L. (2008). Competency: A concept analysis. Nursing Forum, 43, 214-222.

• Benner, P. (2001). From novice to expert: Excellence and power in clinical nursing practice. Upper

Saddle River, NJ: Prentice-Hall.

• Christensen, C.M. (2015). Disruptive innovation. Clayton Christiansen Institute for Disruptive

Innovation. Retrieved from: http://www.christenseninstitute.org/key-concepts/disruptive-

innovation-2/?gclid=CJ_Elve7tMoCFQuLaQodvaoO4A

• Meaney, P. A., Bobrow, B. J., Mancini, M. E., Christenson, J., De Caen, A. R., Bhanji, F.,...Leary, M.

(2013). CPR quality: Improving cardiac resuscitation outcomes both inside and outside the

hospital. Circulation, 128(4), 417-435. doi:10.1161/CIR.0b013e31829d8654

References

• Rogers, E.M. (2003). Diffusion of innovations. 5th ed. New York: Free Press.

• Takase, M. (2012). The relationship between the levels of nurses’ competence and the length of their clinical experience: A tentative model for nursing competence development. Journal of Clinical Nursing, 22, 1400-1410. doi: 10.1111/j.1365-2702.2012.04239.x

• Takase, M., Teraoka, S., Miyakoshi, Y., & Kawanda, A. (2011). A concept analysis of nursing competence: A review of international literature. Journal of Japan Society of Nursing Research, 34, 103-109.

• Valloze, J. (2009). Competence: A concept analysis. Teaching and Learning in Nursing, 4, 115-118.

• Wright, D. (2005). The ultimate guide to competency assessment in health care. (3rd ed.). Minneapolis, MN: Creative Healthcare Management, Inc.