Cardiopulmonary resuscitation frequently marks end of life. Less than 17% of successful resuscitations survive to discharge.

Current healthcare practice does not allow for family members to be with their loved ones during resuscitation.

Family Presence in the Resuscitation Room is endorsed by - The Emergency Nurses Association - The American Heart Association - The American Association of Critical Care Nurses

Less than 5% of critical care areas in the U.S. have a policy allowing family presence during resuscitation.

Methods

Purpose Results

GoalIdentify barriers to family presence in the resuscitation room.

Reinforce the benefit of family presence in the resuscitation room.

Dispel false perceptions of risk to family presence in the resuscitation room.

Encourage a culture of patient and family centered care.

Literature review demonstrates differing opinion between patients, family members and medical staff.

Patient:72% want family present

Family member:75% want to be presentPresence perceived as a right

Healthcare provider:83% disagree with family presence fearing:

-interference with resuscitation efforts-trauma to family members-stress on the healthcare team- medical/legal concerns.

Background

Active and courtesy medical staff members of Baylor Medical Center at Carrollton were asked to participate in a two part study to include an initial survey followed by a ten slide Family Presence presentation with references and repeat survey.

Family Presence during ResuscitationPamela Green, MSN, FNP-C

Linda Roussel, PhD, RN, NEA-BC, CNLUniversity of Alabama at Birmingham School of Nursing

Align clinical practice with evidence regarding family presence during resuscitation.

PICO Question:For medical staff in an acute care setting, does knowledge of evidence change opinion regarding family presence in the resuscitation room?

Step 1: Review of literature and guidelines Identify target population

Step 2: Develop survey Develop education slides IRB approval

Step 3: Distribute initial survey to target population

Step 4: Distribute education slides and second survey to target population

Step 5: Analyze survey results using SPSS statistical program Evaluate effect of education on medical staff opinion.

Significance

References Barrett, F., & Wallis, D. N. (1998). Relatives in the resuscitation room: their point of view. Journal of Accident and Emergency Medicine, 15, 109-111. http://dx.doi.org/10.1136/emj.15.2.109. Doyle, C. J., Post, H., Burney, R. E., Maino, J., Keefe, M., & Rhee, K. J. (1987, February 3). Family participation during resuscitation: an option. Annals of Emergency Prescription, 16:6, 673-675. Jabre, P., Belpomme, V., Azoulay, E., Jacob, L., Bertrand, L., Lapostolle, F., ... Bouilleau, G. (2013, March 14). Family presence during cardiopulmonary resuscitation. The New England Journal of Medicine, 368:11, 1008-1018. MacLean, S. L., Guzzetta, C. E., White, C., Fontaine, D., Eichhorn, D.J., Meyers, T. A., & Desy, P. (2003, June). Family presence during cardiopulmonary resuscitation and invasive procedures: practices of critical care and emergency nurses. Journal of Emergency Nursing, 29:3, 208-221. Meyers, T. A., Eichhorn, D. J., Guzzetta, C. E., Clark, A. P., Taliaferro, E., Klein, J. D., & Calvin, A. (2000). Family presence during invasive procedures and resuscitation. American Journal of Nursing, 100:2, 32-42.

 Indicator

% Agree and Somewhat Agree

Survey #1

% Agree and Somewhat Agree

Survey #2

 Outcome

Family members should have the option to be present during CPR

 55.6%

 69.2%

 13.6% increase

Family members present for CPR have fewer psychological difficulties during bereavement

 50.0%

 53.9%

 3.9% increase

 

FPDR results in higher rates of family satisfaction with care

 55.6%

 69.2%

 13.6% increase

Witnessing CPR causes emotional trauma to family members

 72.2%

 53.8%

 18.4% decrease

Family members who witness CPR are more likely to file lawsuit

 41.2%

 7.7%

 33.5% decrease

FPDR inhibits code team communication

61.1% 46.2% 22.6% decrease

FPDR interferes or interrupts care 61.1% 38.5% 19.4% decreaseComfort with providing psycho-social-spiritual support for family members during CPR

 66.6%

 76.9%

 10.3% increase

Male Female ED ICU GIP Womens Service

Pedi

87.5%

12.5%21.9% 25%

46.9%

3.1% 3.1%

Family Presence during Resuscitation Per-centages based on Gender and Practice Area

(n= 32, response rate 13.4%)

Conclusion: Physician opinion is impacted by the presentation of evidence in support of practice change. Based on the comparison, it would be beneficial to provide education across the Baylor Health Care System prior to formal

policy and procedure for family presence during resuscitation.