Within the past few years, Licking Memorial Health Systems (LMHS) has acquired equipment, digital applications and educational devices to ensure Licking County residents receive the best quality care close to home.  The added technology has increased the likelihood of surviving a cardiac arrest, assisted in streamlining processes for laboratory work and patient care at Licking Memorial Hospital (LMH), and ensured that LMHS personnel are highly trained and maintain life-saving certifications.

To increase survival rates of cardiac arrest patients, LMHS acquired the Lund University Cardiopulmonary Assist System (LUCAS®) – a mechanical chest compression-decompression system.  The machine provides automated, continuous chest compressions as a form of cardiopulmonary resuscitation (CPR).  The emergency procedure combined with artificial ventilation is used to restore spontaneous blood circulation and breathing for a person who is in cardiac arrest in an effort to preserve intact brain function until further measures are taken.  

While LMHS staff members are highly trained in CPR, performing the procedure manually has several drawbacks.  CPR is a physically demanding procedure, as chest compressions must be powerful and fast enough to move blood through the heart.  Individuals tend to be inconsistent in the pressure applied to the chest and compression speed.  It also is vital that compressions continue until the patient is revived or further measures are enacted to restore blood circulation.  In the LMH Emergency Department (ED), staff members performing manual CPR will rotate with another staff member after two minutes of providing compressions to avoid a loss in the quality of the compressions provided.  In addition, manual CPR must be stopped completely in order to use a defibrillator on a patient.  Defibrillators are devices that restore a normal heartbeat by sending an electric pulse or shock to the heart.

Using the LUCAS device offers a safe and more efficient method of providing CPR with consistent, precise compressions.  The patient can be moved from one location to another while the device is in place, and it does not need to be removed when using a defibrillator.  Using three staff members, the LUCAS device can be placed in under 10 seconds.  Each staff member is assigned a task for implementing the device.  One staff member rolls the patient on their side while a second person places the back plate under the patient at chest level.  The third staff member then places the support legs into the back plate with the pressure pad centered over the heart and turns on the device to begin compressions.  Due to the pressure of compression, cracked ribs are often a concern with both manual CPR and the LUCAS device.  Despite the risks, the device promotes a better outcome for patients.  

After the LUCAS device was purchased for the ED, it quickly became part of the Code Blue response at LMH.  A Code Blue is activated when a healthcare provider believes the life of an adult patient is in immediate and severe danger.  The medical emergency is announced over the public address system so that a team of responders can assist in providing life-saving care.  Staff members from the ED take the device into all areas of LMH as needed.  The LUCAS device has proven to be an exceptional life-saving tool, and a second unit was purchased to be kept in the Intensive Care Unit.

To streamline processes and optimize efficiency for patient care, LMHS implemented a new unified electronic health record system.  Epic offers a user-friendly site and application for patients to easily access private medical information and provides numerous new tools for the clinical staff that offers quick access to needed documentation and other information for enhanced patient care.  One such app, Rover, is now being used by the LMH Laboratory, Environmental Services, nurses, point-of-care technicians and others at LMH.  Staff members are equipped with an iPhone loaded only with the Rover app.  As they visit a patient, they scan a bar code on the patient’s wristband and receive information about the patient’s needs including physician orders for medications or laboratory samples, food, and room services.  

For the phlebotomists working with the LMH Laboratory, using Rover with portable printers offers quicker response times for blood draws and decreased mislabeling opportunities.  When a physician or other provider orders laboratory testing, the information is sent to Rover.  The app prioritizes the orders and the phlebotomists are able to quickly respond to the most urgent needs.  They scan patient information from the bar code, obtain positive patient identification, and the labels for the needed samples are sent to the portable printer.  Before the printers and Rover were available, the technicians would have to visit the Laboratory to receive the proper labels or create the labels for the sample containers, which made mislabeling a possibility.  Using the camera on the phone, a scan of the collected samples can be entered into Rover to provide the time of the blood draw or sample collection and ensure timely processing of critical orders.  

Rover also is a valuable tool for those caring for patients.  Nurses and point-of-care technicians can quickly obtain information including vital signs, intravenous (IV) treatment maintenance, medication needs, and test results.  The app also provides numerous alerts that can be activated for better communication.  For example, Rover can alert a nurse when a patient is ready to be transported for or returning from testing so that the caregiver can be present at the bedside.  The new app also assists with quick charting as it communicates directly with the Epic system.  

Technology and equipment also has been beneficial in enhancing staff education and development.  In 2020, a new education center was opened for use in an LMHS building on Tamarack Road.  The center offers two simulation laboratories equipped with the same devices and technology found in patient and ED rooms at LMH.  A control room with a two-way mirror is situated between the two rooms.  From the control room, instructors can observe staff members as they respond to real-life scenarios.

In order to offer the most realistic experience possible in the simulation laboratories, LMHS purchased an adult patient simulator.  Known as Apollo, the simulator is a computerized manikin that can be programmed to recreate a variety of scenarios including cardiac arrest, stroke and trauma.  Using an iPad or laptop from the control room between the simulation labs, an instructor can program Apollo to share information about pain level or provide other hints regarding current health status to test staff members’ response.  The manikin emits breathing sounds, has a discernible pulse and blood pressure, blinks, and can be programmed to bleed or experience other bodily functions.  The pliable skin-like coating is valuable for practicing IV placement, injections and blood draws.  Apollo also can be used to practice intubation, and placing a catheter or a chest tube.

Using Apollo, LMHS staff practice, gain experience and develop clinical mastery in a wide range of patient care scenarios.  The manikin is programmed to respond to the actions of staff members.  Heart rate, blood pressure, and temperature can be monitored utilizing the same equipment and technology found at LMH.  If life-saving measures are performed improperly or too slowly, Apollo’s simulated health declines, triggering alerts and warnings on the other equipment.  Including drastic responses is vital to prepare staff members for stressful situations.

Currently, the simulation labs are utilized during orientation to train and familiarize new staff members with the equipment available at LMH.  The rooms also serve as training for staff members that require bi-yearly certification in Basic Life Support and Advanced Cardiovascular Life Support and those who require training for conscious sedation.  LMHS plans to use the simulation labs as part of a Nurse Residency program that is set to launch in the near future.  Nurses who recently received a degree in nursing will have the opportunity to train every other month in the lab for one year.  The program will offer nurses the opportunity to gain valuable experience and boost confidence when faced with real situations at LMH.  During the training scenarios, the staff members are encouraged to ask questions and receive feedback.

Education is a top priority at LMHS, and the available technology assures that staff members are well-trained and prepared for a variety of clinical scenarios.  Through the acquisition and implementation of medically advanced equipment and software, LMHS improves provider capabilities, patient safety, quality of care, and patient outcomes, which ultimately saves lives.