Cardiopulmonary resuscitation surprise drills: an instrument to improve performance in resuscitation

Introduction

Cardiopulmonary resuscitation (CPR) is an emergency procedure that requires rapid and efficient response, available equipment and personnel trained in life-saving procedures. Since the time component is crucial for saving the patient's life, we must master the skills of life-saving procedures. In 2000, our hospital began implementing surprise drills in adult and pediatric CPR. The aim of the drills is to improve the ability of personnel in the hospital's various departments and units to perform CPR. In the drills, the medical and nursing staff implement the principles of CPR that they have learned in study workshops.

Methods

A doctor and a nurse who are resuscitation instructors conduct the surprise drills using a computerized simulation mannequin (SIM 4000). The instruction team arrives at the department unannounced, presents a clinical scenario, observes the way in which the department functions during the resuscitation process, and documents its findings. At the end of the exercise, a discussion is held with the department staff concerning the quality of resuscitation implementation. Protocols for treatment of potentially fatal arrhythmias are also reviewed during this session. After the exercise, the department head receives a written report of the quality of the CPR exercise, and recommendations for improving CPR management. Implementing surprise drills supplements the CPR training through which the unified language has been introduced into the hospital.

Results

From 2000 to 2003, 50 CPR drills were conducted in clinical departments. Each department has now experienced at least two drills. If deficiencies were detected during the exercise, efforts were made to correct them via departmental meetings concerning CPR procedures and implementation, carrying out specific actions to correct deficiencies, and by inviting the medical and nursing staff to refresher courses in CPR (advanced cardiac life support [ACLS] or basic cardiac life support [BLS]). A total of 1239 medical staff members participated in CPR training from 1999 to 2003, according to the following distribution: BLS, 924; ACLS, 107; pediatric BLS, 136; pediatric advanced cardiac life support, 72. Personnel participating included: nurses, 64% (790); staff physicians, 31% (385); part-time house physicians, 5% (61).

Summary and discussion

We believe that surprise resuscitation drills are the key to improved functioning during actual emergency resuscitation, both on a departmental level and a general hospital level. The benefit of surprise CPR drills lies in the examination of the knowledge level, skills, and the ability to implement them. The department's readiness with equipment and instruments is examined, together with their implementation of CPR protocol. It should be emphasized that this exercise is efficient only after the hospital personnel have undergone basic CPR.