Use of a Nursing Checklist to Facilitate Implementation of Therapeutic Hypothermia After Cardiac Arrest

Abstract

I n the United States, 359 400 people experience an out-of-hospital cardiac arrest each year, and less than 9.5% of those people survive. 1 Out-of-hospital cardiac arrest continues to be associated with high mortality, and among those patients who do survive the initial cardiac arrest, two-thirds die as a result of neurological injury.2 Postresuscitation care is increasingly recognized as an integral component in improving the quality of survival and neurological outcomes. Although advances have been made in initial resuscitative efforts; anoxic neurological injury remains a major concern after return of spontaneous circulation (ROSC).2,3 Therapeutic hypothermia improves neurological outcomes after ROSC. Feature Therapeutic hypothermia has become a widely accepted intervention that is improving neurological outcomes following return of spontaneous circulation after cardiac arrest. This intervention is highly complex but infrequently used, and prompt implementation of the many steps involved, especially achieving the target body temperature, can be difficult. A checklist was introduced to guide nurses in implementing the therapeutic hypothermia protocol during the different phases of the intervention (initiation, maintenance, rewarming, and normothermia) in an intensive care unit. An interprofessional committee began by developing the protocol, a template for an order set, and a shivering algorithm. At first, implementation of the protocol was inconsistent, and a lack of clarity and urgency in managing patients during the different phases of the protocol was apparent.The nursing checklist has provided all of the intensive care nurses with an easy-to-follow reference to facilitate compliance with the required steps in the protocol for therapeutic hypothermia. Observations of practice and feedback from nursing staff in all units confirm the utility of the checklist. Use of the checklist has helped reduce the time from admission to the unit to reaching the target temperature and the time from admission to continuous electroencephalographic monitoring in the cardiac intensive care unit. Evaluation of patients' outcomes as related to compliance with the protocol interventions is ongoing. (Critical Care Nurse. 2015;35[1]:29-38) www.ccnonline.orgCriticalCareNurse that therapeutic hypothermia be used in comatose survivors following ROSC, challenges to implementation of therapeutic hypothermia in clinical practice remain. Therapeutic hypothermia is a complex but uncommon intervention, and because of this, prompt implementation of the many steps involved and quickly achieving the desired temperature goal can be difficult.

The Implementation of Targeted Temperature Management: An Evidence-Based Guideline from the Neurocritical Care Society

“…Shivering must be identified and quantified using consistent language for TTM to be safely and effectively incorporated into patient care. Despite the subjective limitations of the BSAS, it provides common language and has enabled research investigation and bedside evaluation of pharmacologic and non-pharmacologic patient shivering interventions [70][71][72][73][74][75]. More research is needed to develop objective measurement tools.…”

The Use of Checklists Among New Graduate Nurses in a Surgical Intensive Care Unit to Improve Patient Safety and Outcomes

“…Checklists have already been successfully implemented in a variety of settings in health care. The implementation of a checklist was found to increase the rate of a successful and timely implementation of a therapeutic hypothermia protocol in one ICU (Avery et al, 2015). Another meta-analysis concluded that the use of a surgical safety checklist can improve patient outcomes, team communication, and safety (Lyons & Popejoy, 2014).…”