Development of an Advanced Cardiovascular Life Support (ACLS) Team Management in In-Patient Departments, Yala Hospital

Abstract

This action research aimed to: 1) study situations where an Advanced Cardiovascular Life Support (ACLS) team management could apply to inpatient wards at Yala Hospital, 2) develop an effective model for such ACLS team management, and 3) evaluate the outcomes of the ACLS team management in general wards. Research was divided in 3 phases. Phase 1 consisted in a situation analysis based on the concept of survival chain. Sample was composed of 5 groups: 1) emergency physicians, internal medicine physicians, surgeons, intern physicians, 2) head nurses, 3) practical nurses, 4) nurses in  intensive care units, and 5) support staff (helpers/clerks/workers). The instrument used was a structured interview form with validity of .81- .96. Phase 2 consisted in the development of the model by creating a practice guideline for ACLS. The model was then validated by a panel of 5 experts. Phase 3 consisted in the evaluation of the model. The sample consisted of 30 critically ill patients with 6H6T and cardiac arrest.The research instrument was a process questionnaire. Its validity was between .85-1, and Cronbach's alpha coefficient was .68. Data were analyzed using descriptive statistics. 

1. All nurses (100%) in the general ward at Yala Hospital screened critically ill patients according to 6H6T correctly. Most of patients (17 cases) found were hypoglycemia. And the nurses were able to provide the best care of them. In terms of ACLS team management, all steps were tooken by the team, except chest compressions in the correct position, where some of them failed (28.7%). Providing informed consent, and religious concern for the patients were completely done (100%).  And 42.8% of the critically ill patients were referred to a palliative care unit.

2. The management model for the advanced resurrection team in inpatient wards at Yala Hospital was designed from chain of survival, and consistent with the multicultural context in the    southern border areas. Nursing practice guideline for advanced resurrection had five issues in the general ward of Yala Hospital.

3. After training staff at all levels, the results showed that 91.7% of the subjects screened critically ill patients correctly, 72.9% were able to provide surveillance for patients with critical illness management practices, 98.3% were able to practice following the guideline, 87.5% provided care and information and consent for critically ill patients, and 82.3% were able to perform religious services care. And the incidence of cardiac arrest was not found in inpatient wards without plan.