Identifying and Overcoming Barriers to CPR Education in Family Members and Caregivers of at Risk Patients

Judy Vierke, RN, MS, CCNSManager of Education & Prevention

Edward Heart Hospital

David Hiltz, NREMT-PAmerican Heart Association

2

Conflict of Interest DisclosureVierke

• Commercial/industry– No Conflicts to disclose

• Potential intellectual conflicts– No Conflicts to disclose

3

Conflict of Interest DisclosureHiltz

• Commercial/industry– Full-time employment by the American Heart

Association

• Potential intellectual conflicts– Full-time employment by the American Heart

Association

4

Objectives• Identify perceptions and barriers that impact family members of

high-risk cardiac patients from learning cardiopulmonary resuscitation (CPR).

• Discuss how to implement a program that will assist physicians in recommending CPR training for high-risk family members.

• Describe innovative teaching modalities available for reaching community participants with different learning styles and need to increase the number of trained participants available within a community.

5

Facts

• 335,000 Sudden Cardiac Arrests (SCA)

• 163,221 out-of-hospital SCA

• 80 % SCA occur in or near home

• Spouse or family members most likely to witness

6

LiteratureFamily members of high-risk populations:• Benefit from learning CPR• Learn CPR successfully without deleterious

psychosocial consequences• Not likely to seek CPR training• Least likely to actually receive CPR training

7

Alternative methods

must be developed

to market CPR training

to these groups!

8

No CPR Information!

9

Hear no evil, see no evil, speak no evil!

10

Case For Support

G2000 (IIa)

• Families and caregivers of: – infants and children at risk– adults at risk

G2005

11

Charges!

Additional studies are needed(1) To confirm what type of courses lead to

increased participation in CPR training(2) Describe factors that prevent healthcare

professionals from recommending CPR training to families of at-risk patients

(3) Identify CPR training methods that are most attractive to families and caregivers of at-risk patients

12

Edward Heart Hospital

13

Institutional CultureProgressive Heart Hospital• Focus on Patient, Family and Staff Education &

Prevention• Alliance with American Heart Association (AHA)• AHA Training Center• Presence in Community for Cardiac Education &

Prevention, CPR & AEDs

• Resistance to discussing CPR with families

14

Research Questionnaire

• Institutional Review Board (IRB)

• Patient Survey

• Family Member Survey

• Physician / Advanced Practice Nurse (APN) Survey

15

Patient Surveys

• Distributed through Cardiac Rehab

• 31 surveys returned

• Mean age 65

• 68 % male

• 81 % lived with family / friends

16

Patient Survey

• 94 % think that knowing CPR is important for family members of people with heart disease

• 97 % would encourage their family members to learn CPR

17

Patient Survey

• 53 % would have liked a healthcare professional to have discussed options of CPR with their family

• Only 30 % of the time did a healthcare professional discuss / recommend CPR training with family

18

Patients want us to discuss CPR more with their families!

19

Family Survey

• 24 surveys returned – 7 patients lived alone

• Mean age 59• 73 % would have liked a healthcare

professional to discuss CPR options• Only 21 % stated a healthcare

professional discussed CPR

20

Family Survey

• 95 % think CPR is important for family members of people with heart disease

• 86 % felt they are able to acquire knowledge and physically capable of learning CPR

21

Family Survey

• 50 % had prior training in CPR– 82 % greater than 2 yrs ago– 91 % had no training in AEDs

• Only 24 % felt “somewhat confident” in their CPR skills

• 76 % “unconfident” in skills

22

Family Survey

• Reasons for not taking CPR– 50 % never thought of it *– 33 % not a priority *– 8 % lack of information *– 8 % anxiety *

* Healthcare Professionals can assist in overcoming these barriers

23

Family Survey – Likely to Take CPR If …

• 87 % Info available

• 91 % Health professional / Physician

recommend

• 100 % No written test

24

Family Survey

• What is the ideal class style / learning model?– 50 / 50 split– Traditional instructor class vs. home self study– No statistical difference

• age or educational level

25

• Families want us to discuss CPR with them

• Families are uncomfortable with their CPR skills

• We can impact number of families becoming trained

Key Points:

26

Physician / Advance Practice Nurse (APN) Survey• 26 Surveys • Mean age 43• 31 % Internal medicine• 19 % Cardiology• 15 % Family Practice • 15 % APN• 19 % Other

27

Physician / APN Survey

• 35 % both BLS & ACLS

• 23 % BLS

• 8 % ACLS

• 19 % have performed CPR out of the hospital setting

28

Physician / APN Survey

Routinely Counsel on:

• 100 % Risk factor modification

• 81 % Warning signs of heart attack

• 73 % Importance of calling 911

29

Physician / APN Survey

Reasons for not recommending CPR

• 54 % Lack of information on classes

• 50 % Never thought of it

• 27 % No time

• 12 % Concerns of anxiety

• No one felt it was inappropriate

30

Name: ___________________________Date: __________              

Education Prescription ___ Cardiac Rehab/Exercise                           Call 630-527-3388___ Diabetes Education                                     Call 630-527-3213___ Heart Coach                                 Call 630-527-2825___ Metabolic Syndrome / Weight Loss        Program                                                     Call 630-527-2825___ Cardiovascular Screenings         For Loved Ones                                         Call 630-527-2825                ___ Ultrafast Heart Scan                ___ Stroke & Vascular Screening                ___ Cholesterol Screening  ___ Stress Workshop                 ___ Delicious Meets Nutritious ___ Blood Pressure Workshop ___ Smoking Cessation___ Cholesterol Workshop        ___  CPR for Loved Ones         Call 630-527-6363 for dates, fees, and registration. Signature: ______________________________, M.D./R.N.

additional information on back

100 % Physician / APN Supportive of CPR Script

31

Next Steps

• Adding CPR to our education prescription• Monitor enrollments to CPR classes from

education prescription• Re-survey physician / APN for changes in

practice• Investigate & implement CPR Anytime

program with inpatients & physician offices

32

Vision

• Create and implement an initiative that will increase enrollment in the CPR courses and help to improve the health of our community

• Promote the important messages about cardiac emergencies and CPR

• Improve cardiac arrest survival rates by increasing the number trained in bystander CPR

• Create a program that provides an excellent example of how to work with physicians for a healthier community

33

A Physician CPR Prescription Program

provides a mechanism for physicians to:

• advocate for CPR training

• increase the number of family members of at-risk patients who recognize the signs of an emergency, know when to phone 911, and know how to perform cardiopulmonary resuscitation (CPR).

34

Case for Support!

• Most cardiac arrests occur

in and around the home

• At-risk population is

underserved

• Power of physician influence

is well established

35

How it Works

• Physicians agree to be a part of the Physician CPR Prescription Program

• Participating physicians are provided with a description of the Physician CPR Prescription Program and pre-printed CPR prescription pads

• The patient and/or a family member calls the predetermined contact information for CPR courses being offered and enrolls in a CPR for Family and Friends course

36

Rx pad is preprinted with the Rx pad is preprinted with the physician group logo and the physician group logo and the

information needed to locate an AHA information needed to locate an AHA CPR course.CPR course.

Anytown Cardiology Associates

555 Main Street

Anytown, USA 55555

NAME AGE

ADDRESS DATE

SIGNATURE Dispense as Written

No Substitutions

American Heart Association

CPR for Family and Friends Course

Call 1-877-AHA-4CPR to Enroll Now

37

““Quick Facts” preprinted on backside Quick Facts” preprinted on backside of Rx to assist physician in delivering of Rx to assist physician in delivering

the persuasive CPR message to the persuasive CPR message to patients and their families.patients and their families.

70 – 80% of the cases that require CPR occur in and around the home – so it is going to be up to each one of us to save our loved ones.

The best time to learn CPR was yesterday –tomorrow may be too late.

CPR is easy to learn do it today!

CUSTOM MESSAGE HERE

38

Theoretical Example

• 10 physicians participate

• Each physician provides 100 CPR course referrals over 1 year

• 400 – 600 learn early

warning signs and

how to perform CPR

39

Changes

EVERYTHING!

™ CPR Anytime

40

What Changes?

• More barriers removed

• Increased efficiency

• Easier to fund/sponsor

41

Small Pilots in Rhode Island

42

Pilots

South County Cardiology Associates and

Cardiovascular Associates of RI

• Buy-in from senior associates

• MD RX methods

43

Pilot Goals

• “Gut check” – see if it works!

• Further validation of theory

• Ramp-up for larger study

44

Pilot Results

• It works!

• Theory validated

• Implementers excited!

45

Endorsement

Partner opportunities!

46

• Additional experience will identify an effective means to prompt enrollment in CPR courses

• Additional work is also needed to determine the overall effectiveness of the initiative

47

• Further investigation can lead to a method for overcoming factors that prevent healthcare professionals from recommending CPR training to families of at-risk patients.

• This work will also identify the methods that make CPR training attractive to families and caretakers of at-risk patients.

48

Materials Created

• PowerPoint

• Guide

• Templates

• Marketing Collateral

• Press Release

49

Summary

We can impact lives saved!

• Patients & families want us to discuss CPR • Families are uncomfortable with their CPR skills• We can overcome barriers• We can impact number of families trained• Alternative innovative options need to be explored• CPR Prescription & CPR Anytime have a role

50

Questions

51

Judy Vierke, RN, MS, CCNSManager of Education & Prevention Edward Heart Hospital630-527-2830jvierke@edward.org

David Hiltz, NREMT-PSenior Regional ManagerAmerican Heart Association401-330-1721david.hiltz@heart.org

52

ReferencesGuidelines 2000 for Cardiopulmonary Resuscitation and Emergency

Cardiovascular Care: International Consensus on Science. Circulation. 2000;102(suppl I):I-8

Guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC). JAMA. 1992;286:2135-2302

Chu KH, May CR, Clark MJ, Breeze KM. CPR training in households of patients with chest pain. Resuscitation. 2003;57:257-268.

Dracup K, Moser DK, Taylor SE, Guzy PM. The psychological consequences of cardiopulmonary resuscitation training for family members of at risk for sudden death. Am J Public Health. 1997;87:1434-1439

Dracup K, Moser DK, Taylor SE, Guzy PM, Marsden C. Is cardiopulmonary resuscitation training deleterious to family members of at risk patients? Am J Public Health. 1994;84:116-118

Dracup K, Heany DM, Taylor SE, Guzy PM, Breu C. Can family members of high-risk patients learn cardiopulmonary resuscitation? Arch Intern Med. 1989;149:61-64

53

ReferencesGoldberg RJ, Gore JM, Love DG, Ockene JK, Dalen JE. Layperson

CPR – Are we training the right people? Annals of Emergency Medicine. 1984; 13:9:89-92.

Goldberg RJ, DeCosimo D, St. Louis P, Gori JM, Ockene JK, Dalen JE. Physicians’ attitudes and practices toward CPR training in family members of patients with coronary heart disease. AJPH. 1985;75:281-283.

Platz E, Scheatzle MD. Pepe PE, Dearwater SR. Attitudes towards CPR training and performance in family members of patients with heart disease. Resuscitation. 2000.;47:273-280.

http://www.ajph.org/cgi/content/abstract/87/9/1434

54

Thank You!