Elsevier

Resuscitation

Volume 78, Issue 1, July 2008, Pages 59-65
Resuscitation

Training and educational paper
Evaluation of staff's retention of ACLS and BLS skills

https://doi.org/10.1016/j.resuscitation.2008.02.007Get rights and content

Summary

Objectives/purpose

To test registered nurses’ abilities to retain basic or advanced life support psychomotor skills and theoretical knowledge.

Design

A repeated-measures, quasi-experimental design was used.

Methods

Written and performance tests (initial, post-training, and final testing) used scenarios requiring performance of advanced cardiac life support (ACLS) or basic life support (BLS) skills. Final testing was by random assignment to 3, 6, 9, or 12 months.

Sample

A convenience sample (n = 133) was used.

Instrumentation

American Heart Association 2000 ACLS and BLS evaluation tools were used in a simulated testing environment.

Findings

Findings show nurses retain theoretical knowledge but performance skills degrade quickly. ACLS skills degrade faster than BLS skills with 63% passing BLS at 3 months and 58% at 12 months. Only 30% of participants passed ACLS skills at 3 months and 14% at 12 months. These findings are similar to the results of other investigators in over a decade of research.

Conclusions

Study results showed a decline in skills retention with nurses unable to perform ACLS and BLS skills to standard for the entire certification period. The need for more frequent refresher training is needed. No formal research at this institution indicates skill degradation adversely affected patient outcomes. Further research on ACLS and BLS course content, design, management, and execution is needed.

Introduction

Annually, 350,000 cardiac arrests occur in the United States. When applied correctly, advanced cardiac life support (ACLS) and basic life support (BLS) restores circulation in 40–60% of cases1; provides oxygenation and restores spontaneous circulation and brain function.2 Nurses must be proficient in ACLS and BLS to respond. This study assessed hospital-employed RNs’ abilities over time to provide ACLS or BLS to American Heart Association (AHA) standards in a simulated environment.

Goals of BLS training are for staff to respond correctly to cardiac arrest, respiratory arrest, and foreign-body airway obstruction. Classes include tests of knowledge and psychomotor skills. ACLS builds upon BLS knowledge and skills.

ACLS organizes in-hospital treatment of cardiac arrest using life-saving algorithms.3 Poor performance of resuscitation may result in poor outcomes, such as patients who remain in vegetative states.

Healthcare professionals require skills and knowledge for successful resuscitation.4 Most hospitals require personnel to be certified in BLS every 2 years. RNs working in intensive care units and emergency departments may need ACLS certification.

Studies of healthcare and lay rescuers show that resuscitation skills degrade quickly and knowledge is retained longer than skills.5, 6, 7 Variables affecting skills retention are many and difficult to isolate. Factors that negatively affect retention are (1) insufficient hands-on practice, (2) inconsistent teaching, (3) unrelated course content, (4) complex instruction, (5) delays between instruction and skills practice, (6) lack of supervision, (7) low instructor feedback, and (8) instructor incompetence. Factors that positively affect skills retention include: (1) hands-on practice, (2) instruction simplicity, (3) multi-media presentations, and (4) feedback from instructors.5, 6, 7

Most research was completed before the International Liaison Committee on Resuscitation (ILCOR) 2000 changes in ACLS and BLS. Studies of RNs show similar findings on retention of skills. Problems with past studies are small convenience samples, lack of inter-rater reliability, and no comparison groups.

Section snippets

Materials and methods

This study sought to find the point at which RN skills and/or knowledge of ACLS and/or BLS degrade such that they do not meet AHA standards. Results may be used to design refresher training to bring skills back to standard.

Results

Demographic data for the groups are shown in Table 1, Table 2.

Discussion

Findings in this study are consistent with previous literature and demonstrate short retention times of skills in both BLS and ACLS (10, 11, and 16). The initial failure of BLS resuscitative skills (71.2%) was interesting considering that 50% of participants reported taking a BLS course within 1–3 months prior to testing.

Skills degradation was expected to occur in a linear fashion over time for both groups. The linear degradation would be present if the 9-month group performed as expected. The

Conclusions

This study identifies a significant problem: RNs in clinical settings may not perform life-saving ACLS and BLS skills to AHA standards. Retention of both basic and advanced resuscitation skills is short. ACLS and BLS skills retention needs to improve to reduce the potential risk of death and disability secondary to delay in resuscitation. Recommendations to improve RN skills retention from this research study are

  • 1.

    More frequent refresher training.

  • 2.

    Allow more time for hands-on skills practice.

  • 3.

Conflict of interest

None.

Acknowledgements

This research was sponsored by the TriService Nursing Research Program, Uniformed Services University of the Health Sciences; however, the information or content and conclusions do not necessarily represent the official position or policy of, nor should any official endorsement be inferred by, the TriService Nursing Research Program, Uniformed Services University of the Health Sciences, the Department of Defense, or the U.S. Government.

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A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2008.02.007.

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