(1526) The Impact of a Cardiac Arrest Prevention (CAP) Bundle on Nursing Empowerment

Introduction: The bedside nurse (RN) is critical in preventing cardiac arrest (CA) in post-operative cardiac patients in the pediatric intensive care unit (PICU). In addition to reducing CA rates in PICU, this quality improvement (QI) project aimed to measure nursing perception of the implementation of a cardiac arrest prevention (CAP) bundle and their perception of understanding their patient’s risk for deterioration.

Methods: This QI project utilized a quantitative descriptive design which compared pre-implementation and post-implementation surveys of the CAP bundle. Survey results were collected pre-implementation, 3-, 6-, and 12-month post-implementation. Questions measured RNs perceptions on intervening before arrival of providers, inclusion in management plan discussions, and awareness of ECMO candidacy utilizing a Likert scale.

Results: RNs (n=44) completed a pre-implementation nursing survey analyzing current thoughts regarding patient deterioration, planning for decompensation, and prevention of CA in cardiac patients. Most of the time or always, RNs reported they were not aware of a mitigation plan for deterioration (n=6, 13.6%). This involved a lack of bedside RNs included in plan-of-care discussions (n=12, 27.3%) and not knowing if their patient was an ECMO candidate (n=3, 6.8%).

The final survey was completed by RNs (n=39) one-year post-implementation. After implementation of the project, nearly 80% of RNs (n=31, 79.5%) reported being aware of a mitigation plan for deterioration. In addition, more than 80% of RNs (n=33, 84.6%) were included in plan-of-care discussions, and knew if their patient was an ECMO candidate (n=33, 84.6%). In addition, more than 95% of RNs reported having a specific plan for deterioration would decrease CA in the PICU. RNs (n=31, 79.5%) felt prepared to intervene on their decompensating patient and were less likely to wait for a provider before doing so (n=8, 20.1%). Additionally, nearly 95% of RNs surveyed (n=37, 94.9%) reported the CAP bundle helped them understand their patients' risk for deterioration better.

Conclusions: Implementation of the CAP bundle was successful in empowering PICU RNs to intervene on a deteriorating patient sooner. RNs viewed the project favorably as they were included in plan of care discussions and able to execute interventions faster.