ACEN - the Australian College Of Emergency Nursing provides trauma and paediatric training courses for nurses

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Position statements Clinical Practice - Nurse Initiated Defibrillation of Adults

Purpose

Cardiac arrest in adults occurs both in and out of the hospital environment. The causes are myriad, but the expectations of the community are always the same; that professional nurses are able to provide appropriate methods of resuscitation in these situations.1.

Most adults who can be saved from cardiac arrest are individuals in Ventricular Fibrillation (VF) or Pulseless Ventricular Tachycardia (VT). Electrical defibrillation provides the single most important therapy for the treatment of these patients. Resuscitation science, therefore, places great emphasis on early defibrillation.2.

The greatest chance of survival results when the interval between the start of VF and the delivery of defibrillation is as short as possible.2,3. To achieve the earliest possible defibrillation, the Australian Resuscitation Council (ARC) recommend that all first responding emergency personnel, whether physicians, nurses or non- medical personnel, should be authorised, trained, equipped and directed to operate a defibrillator if their professional responsibilities require them to respond to persons in cardiac arrest.2.

College Position

The evidence indicating that early defibrillation is the critical factor influencing survival for persons suffering cardiac arrest is irrefutable.

The College believes that the educational preparedness of registered nurses is adequate and sufficient to learn, in addition to Basic Life Support (BLS), the principles and practice of defibrillation.

he easier to use automated defibrillators make it possible for a wider range of responders to learn this skill. Where educational preparation in the use of standard manual defibrillators is appropriate only for registered nurses with current Advanced Life Support (ALS) competence, the College believes that educational preparation in the use of automated defibrillators can and should be extended to enrolled nurses. The College believes that semiautomatic external defibrillators (SAED) should be provided as a standard in all health care areas.

Position Guidelines

Employer Responsibilities
Employers are responsible to:

  • Ensure their facilities are financial subscribers to the ARC, and maintain the manual +/or website to be current, complete and accessible.
  • romote the necessity of education programs for the establishment and maintenance of BLS and defibrillation skills.
  • Ensure that they review their resuscitation policies and procedures to reflect the fact that defibrillation by nurses, who are usually the first on the scene, provide the best opportunity to decrease time to defibrillation. Establish and encourage SAED training as a basic skill for health care providers working in settings where ALS professionals are not immediately available.
  • Extend training and authorisation to use conventional and automated defibrillators to all appropriate non physician staff, including nurses.
  • Provide training testing and refresher opportunities as required.
  • Establish an interdisciplinary committee, with expertise in Cardio Pulmonary Resuscitation (CPR) practices, to assess the quality and efficacy of the facility’s resuscitation efforts.

Employee Responsibilities
Employees are responsible to:

  • Attend training session/s offered.
  • Maintain competency throughout employment period.
  • Document and report all cases of cardiac arrest.
  • Work with employer to develop strategies and protocols to best enable practicable implementation of policies and procedures.

Joint Responsibilities

  • All parties should support and conduct relevant research at the local and national level that will continue to inform and enhance resuscitation practice.
  • To be collaborative in all matters related to the prevention and management of cardiac arrest.

References

  1. Royal College of Nursing Australia (RCNA) (2000) The role of nurses in the management of cardiorespiratory arrest. Position Statement. www.rcna.org.au
  2. Australian Resuscitation Council (ARC) (1997) Early Defibrillation. Policy statement No 11.7.1
  3. Finn,J. and Jacobs, I. (2003) Cardiac arrest resuscitation policies and practices: a survey of Australian Hospitals MJA Vol 179, 3 November pp 470-47.