Emergency Response Training in a

Pediatric Ambulatory Setting

Gayle Young, BSN, RN, CPEN
Sharon Wright-Speice, MSN, RN, CPEN
Learner Outcomes for the Day
• Discuss development of emergency response training in a
pediatric ambulatory setting
• Describe learner-specific actions to enhance training
• Evaluate effectiveness of training
History and Development
Identify ambulatory groups over three hospital campuses

Outpatient Health Off-site

Clinics (36) Centers (9) Centers (2)
History and development
• Historical emergency response training for ambulatory
staff
• Basic Life Support (BLS) requirement
• Mock codes in clinics and centers
• Educational assessments identified a need for formal and
comprehensive pediatric emergency training
History and development
• Pediatric Emergency Assessment, Recognition, and
Stabilization (PEARS)- best option
• AHA Educational Guidelines
• Consistent, contextual, hands-on practice, debriefing, and
evaluation
• Goal - 440 staff PEARS-certified by October 2018
• Monthly classes to start October 2016
• Led by Nursing Professional Development (NPD)
History and development
• Identify Key Stakeholders
• Ambulatory Educators
• Development - to become PEARS Instructors
• Ambulatory Participants- Nurses and Medical Assistants
(MAs)
What is PEARS?
• P : Pediatric
• E : Emergency
• A : Assessment
• R : Recognition
• S : Stabilization
Program Description
PEARS® is an American Heart Association (AHA)
course that helps develop healthcare providers knowledge
and skills essential for emergency evaluation and initial
stabilization of the seriously ill infant or child.
PEARS Learner Outcomes
• Pediatric assessment
• Assessment and management of respiratory problems
• Recognition and management of shock
• Identification and management of cardiac arrest
• Practice resuscitation team concept
PEARS Group Dynamics History

MA Overall
Poor Test Low
Scores Attendance

MA
Lack
Engagement
New Program Development
• Developed Pediatric Identification of Emergency and Response
(PIER) to meet the need of the emerged target group
• PIER is for unlicensed healthcare personnel
• PIER content is based off the PEARS for consistency
What is PIER?
• P : Pediatric
• I : Identification
• E : Emergency
• R : Response
Difference in PEARS vs PIER?
PEARS PIER

ASSESSMENT: IDENTIFY:
Nurses will identify, assess, and manage a MAs will identify a deteriorating patient and
deteriorating patient notify a nurse and/or provider

Nurses receive an MAs receive a

American Heart Association (AHA) Certificate of completion
Certification Card
Difference in Learner Outcomes?
PEARS
• Assessment and management
of respiratory problems
• Assessment and management
of shock
• Assessment and management
of cardiac arrest
• Practice resuscitation team
concept
PIER
• Recognize a seriously ill or
injured child by abnormal
• Respiratory signs and symptoms
• Skin color
• Vital signs
• Perform basic life support (BLS)
• Effective team interaction within
scope
Difference in Skills Stations?
PEARS PIER
• Code cart • Code cart
• Utilize code cart supplies, • Identify and retrieve key code
medications, and equipment cart supplies and equipment
• Defibrillator/AED • Defibrillator/AED
• Operate AED • Operate AED
How Effective was the Training?
Confidence Survey
• Measure change (+/-) in the level of Post-Class
ConfidenceEvaluation
Survey
the participants confidence and
perception

Post-Class Evaluation
• Measure if the program met the
learning outcomes
PEARS Pre & Post Survey Data
n=41
PIER Pre & Post Survey Data
n=43
Question / Indicator Pre Post
1. I understand my responsibilities in an emergency situation with an ill or 3.3 3.8
inured child
2. I understand how and when to get help in an emergency situation for 3.4 3.8
an ill or injured child
3. I am confident in my ability to recognize abnormal respiratory signs 3.4 3.8
4. I am confident in my ability to recognize abnormal skin color and vital 3.4 3.8
signs.
5. I can identify equipment needed in an emergency situation for an ill or 3.1 3.8
injured child.
6. I know how to initiate the steps of basic life support (BLS) for an infant 3.4 3.8
or child.
PEARS Evaluation Summary
Scores
Scores Range:
Range: 4.94
4.94 –– 4.99/5.0
4.99/5.0
Comments
Comments Include:
Include:
•• Strength-
Strength- openopen discussions,
discussions, team
team problem
problem solving.
solving.
•• II really
really liked
liked the
the action
action part
part of
of putting
putting itit all
all together-
together- actually
actually moving
moving andand
getting
getting supplies
supplies from
from the
the cart,
cart, etc.
etc.
•• Classroom
Classroom greatgreat for
for asking
asking questions
questions and
and getting
getting feedback.
feedback.
•• Good
Good pace.
pace. Enjoyed
Enjoyed class
class size.
size.
•• The
The discussion/videos
discussion/videos formatformat isis more
more effective
effective to to me
me than
than just
just listening
listening to
to
someone
someone speak.speak. The
The case
case studies
studies were
were veryvery helpful.
helpful. Scenarios
Scenarios were
were
helpful.
helpful.
PIER Evaluation Summary
Scores
Scores Range:
Range: 4.9
4.9 –– 5.0/5.0
5.0/5.0
Comments
Comments Include:
Include:
•• ItIt was
was great
great to
to be
be familiar
familiar with
with the
the crash
crash cart
cart in
in case
case of
of emergencies.
emergencies.
•• Class
Class was
was much
much more
more informative
informative for for an
an MA
MA vs.
vs. PEARS.
PEARS.
•• Very
Very informative,
informative, veryvery interactive,
interactive, great
great for
for hands-on
hands-on learners!
learners!
•• Loved
Loved it-it- makes
makes mymy role
role in
in clinic/emergency
clinic/emergency situation
situation have
have more
more clarity!
clarity!
•• More
More focus
focus onon our
our role
role of
of assisting
assisting and
and not
not leading
leading inin an
an emergent
emergent
situation
situation duedue to
to lack
lack of
of experience
experience compared
compared with with our
our nursing
nursing team
team
members.
members.
Questions?
More Information?
References

American Heart Association. (2017). About CPR & First Aid. Retrieved from

http://cpr.heart.org/AHAECC/CPRAndECC/AboutCPRFirstAid/CPRFactsAnd

Stats/UCM_475731_Out-of-hospital-Chain-of-Survival.jsp

American Heart Association. (2012). Pediatric emergency assessment, recognition, and

stabilization. : First American Heart Association.