Are we really as good as we think we are?

I’ve always suspected that some students come to class for certification only to return to their place of employment to provide patient care that resembles nothing that was taught in class.  In many instances these students are experienced clinicians who have good intensions but intentions based on false reality. 

Stay with me…

In many instances people think they provided appropriate care however the reality is that the care rendered was less than ideal.  Regardless of the system, EMS, ER, Code Team, Surgery, Post Op; etc.… each system is made up of motivated, genuinely caring, and highly educated individuals that over time can lapse into routine and bad habits. 

The issue isn’t the failure of the system to meet the standard, but instead over time, substandard becomes the norm.  The distinction, though, is important. 

While ages vary, a large majority of cardiac arrest patients involve the elderly, having multiple health issues with other contributing factors.  During these incidents, the “code team” will arrive to attempt to resuscitate the patient and in the case of an unsuccessful resuscitation, everyone would simply consider it ‘the patient’s time.”  I mean, he/she was elderly, had an extensive medical history with other contributing risk factors.  Had they failed to resuscitate him/her, that would have been sad, and tragic, and…perfectly acceptable for all the same reasons. *

* How Hospitals Kill Our Loved Ones And Conceal It, March 17, 2017

The disturbing part is in the case of a successful resuscitation, the team will be congratulating itself for saving his/her life while overlooking long pauses in CPR, late medications, improper defibrillation, not switching chest compressors every two minutes, or CPR that isn’t 30:2 as taught in class….

We haven’t even discussed return of spontaneous circulation (ROSC), in some instances we make things worse rather than better.  The patient just came back from the dead and we tend to want to administer fluid (fluid overload) or slow a heart rate that is fast secondary to Epi administration.  We need to give the patient time to normalize.  I’m not saying withhold treatment from a symptomatic patient.  What I am saying is “the enemy of good is better” especially in the ROSC state. 

We have all been on those resuscitations where everything went well, we were on top of our A game and all things worked for the good of the patient.  I would hope those arrest cases outweigh the ones where northing we did reflected the standard taught in class. 

It is reported that medical errors are the third leading cause of death in the US.  More alarming is that number does not reflect the number of deaths caused by the deficiencies in the standard of care.  Many times, patients die of what seems robbing Peter to pay Paul, when and one complication leads to the next issue; when in reality poor treatment was the cause of the decline in the patient’s condition. 

A standard of care is simply that, a standard and over time with good intentions and poor habits the standard can become substandard but considered the norm.  In these instances, a bad outcome is an expected reality, rather than the reality check it ought to be. 

To be clear, sick people will die even when care is appropriate. But when patients die due to a substandard of care, the failings go unnoticed. 

My challenge to each of you is to question yourself and the system.  Did you do everything possible to ensure a successful resuscitation?  Was CPR 30:2, interruptions in CPR less than 10 seconds, were shocks and medications appropriate and timely?  Did the standard of care regress to innumerable and unnecessary lapses in treatment?  Did the patient survive despite our best efforts to kill them?

Take a look at the big picture, debrief after every resuscitation attempt have the courage to discuss what went well and what can be improved upon.  The standard of care is a veil over its own potentially lethal inadequacies. 

Clinicians can unknowingly contribute to a patient’s death, despite hard work and good intentions, and conceal it even from themselves. It hides in plain sight; it is business as usual. It is up to all of us to self-reflect, is my medicine as good as I think it is?  Is there something I can do or the system can do better during a resuscitation?  Cross the T’s, dot the I’s, be an advocate for both the patient and good medicine. 

#practice #acls #pas #smallbusiness #cpr #aha

- Brian Davis

Heartland CPR, llc

405-603-6666

www.HeartlandCPR.com