Incorporation of ACLS in the new grad Education

Aim: : New graduate nurses were coming out of orientation with their ACLS certification but without a clear understanding of what they were doing and why. We initiated a learning format, that while in orientation broke down different aspects of ACLS and allowed time to focus on rhythm identification, drug understanding, and hands on use of the equipment to increase comfort in code situations.

Framework:: PDSA

Setting:: Level 1 academic teaching facility in the Southeast.

Stakeholder Team:: Nurse educators conducted the training while in new graduate orientation.

Methods: : Historically ACLS has been a one day class that was taken within the first 6 months of being hired. When taking ACLS for the first time these nurses have had zero to minimal exposure in emergency code situations. After observing new grad nurses in these situations and their unfamiliarity with what to do, how to use the equipment, and being uncomfortable asking questions, it was decided to re-vamp the way ACLS is taught to new grads in the ED.
During the new grad nurses classroom time we broke ACLS up into segments to allow a certain rhythm to be better focused on. They have one week per month of classroom time.

During week 1 of class: Focus is shockable rhythms. During this time they learn what rhythms are shockable, how to identify them, medications used to treat, hands on practice with the Zoll, and code sheet documentation.
During week 2 of class: Focus is cardioversion. During this week they learn to identify rhythms that can be cardioverted, medications used to treat, and hands on practice with the Zoll.
During week 3 of class: Focus is on pacing. During this week they identify the rhythms that may need to be paced and how to determine if they are needing pacing or not, medications that can be used, and hands on with the Zoll.
During week 4 of class: We mix the rhythms together and give them practice with a mock code situation.
Throughout orientation, even when they are out of the classroom time, we also join some of the residents and pharmacy with mock code situations in the SIM lab. This allows new nurses to develop a relationship with other members of the ED team and allows them to be more comfortable speaking up in emergency situations.

Outcomes:: Through the new process we have improved ACLS knowledge in the emergency department, skill performance, and have improved patient outcomes as evidenced by improved classroom pre and post-knowledge base tests. ACLS scores improved. In actual ACLS codes there was an improvement in the knowledge of rhythm identification and what medications should be used to treat. Physicians noticed that staff were better prepared in emergency situations.

Implications:: Using the new ACLS education platform other emergency departments could experience increase comfort of staff with successfully implementing ACLS guidelines to improve patient outcomes. This new process requires little additional resources besides the educators time.