Revolutionizing CPR Training: The Power of RQI in Health Care and Education

In this episode of NLN Nursing Edge Unscripted, hosts Dr. Kellie Bryant and Dr. Raquel Bertiz welcome guests Dr. Sarah Beebe and Dr. Donna Guerra to discuss Resuscitation Quality Improvement (RQI) and its impact on CPR training. They explore how RQI's simulation-based, self-directed model enhances skill retention by replacing traditional biennial certification with quarterly, high-frequency, low-dose training. The guests share success stories demonstrating how RQI has boosted provider confidence and improved patient outcomes, including students effectively performing CPR in clinical settings. They discuss the implementation process in academic and healthcare institutions, addressing challenges, faculty and staff engagement, and system maintenance. The episode concludes with tips for organizations considering RQI, emphasizing clear communication, early staff buy-in, and the long-term benefits of integrating this innovative training approach.

Learn more about the RQI for Nursing Education program.

Research on RQI

Implementation of the RQI System: Baseline Skills and Self-Report Competence and Confidence Data From 12 NLN Inaugural Change Agent Nursing Programs Authors: S. Kardong-Edgren, D. Nikitas, E. Gavin, et al. Nursing Education, 2025 Mota, S. (2023). Resuscitation quality improvement: improving clinicians’ performance. AACN Advanced Critical Care, 34(3), 182-188.

Mota, S. (2023). Resuscitation quality improvement: improving clinicians’ performance. AACN Advanced Critical Care, 34(3), 182-188.

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Transcript

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[Music] Welcome to another edition of the NLN Nursing EDge Unscripted podcast. I am your host today  Dr. Kellie Bryant and I'm joined by our co-host Dr. Raquel Bertiz and we both work at the National  League for Nursing. In this episode today, really excited about this episode, we're going to be  discussing the Resuscitation Quality Improvement also known as RQI that is revolutionizing the  way that we deliver CPR education. So for those of you that don't know about RQI, just a quick  introduction about RQI. It is a way to maintain CPR competencies. It is a digital and simulation-based  training that delivers high realistic and lifelike scenarios that build confidence among its users  and also competencies without the constraints of doing the traditional CPR training in the  classroom. These are self-directed, science-based approach that allows providers to train on their  own time and they spend more time with their patient and less time in the classroom. It  covers basic life support, pediatric advanced life support, and they also have advanced cardiovascular  life support also known as ACLS. So it is backed by research. We have some research articles about  RQI that we'll share links to at the end of this podcast. So to get us started, I'd love to introduce  our guests today. First guest is Dr. Sarah Beebe and she is a simulation center program manager at Bay  Health Medical Center in Delaware. And we also have Dr. Donna Guerra who is currently the clinical  associate professor in the College of Nursing at the University of Alabama in Huntsville. So warm  welcome, thank you for being here with us today. Thank you. Thank you. So we're going to dive right  in. First question - tell us a little bit about RQI and how you're using it at your institution. And  I'll start with you Dr. Beebe. Yes, thanks. So I work at a health care center in Delaware. We have  two hospitals, two freestanding ERs and then also a number of urgent cares and outpatient  clinics as well and we use RQI. We initially rolled it out just in the hospital setting, but  now we have RQI carts or the device that the manikins and the computers sit on, we have them  throughout the hospital, our freestanding emergency departments, and then one of our large urgent care  and outpatient clinics as well. And what about you Dr. Guerra? How are you using our RQI at your institution?  So we are a college of nursing that offers from BSN, MSN ,to PhD and DNP. We do offer RQI as a means  for BLS training for any of our nursing students who are interested in doing that or our faculty,  but we require it in the traditional BSN track of our undergraduate program. So a lot of schools,  I know when I went to nursing school, you had to do your CPR training and kind of before you go  to school, bring in a copy of your card, it was put into your record and you were good for two years,  you know and I think a lot of places are still probably doing that same method. So what made your  institutions decide to to try RQI and and  track CPR in a different way? How did you come  to that decision? Since you brought that up about how we traditionally do that in nursing education,  we did that as well. And in 2022 the NLN and Laerdal with RQI put out a call for colleges  of nursing or other institutions that wanted to be early adopters of this technology with  BLS. And we were one of 12 nursing programs nationwide selected to  be change agents in nursing education in implementing RQI in our nursing programs. And what about you Dr. Beebe? How did how did you come up... you're in a clinical setting, which  is great. In academia but also clinical. Yeah, so a a big part of it was to get our staff back doing  what they wanted to do, which was be at the bedside. Nobody wants to sit in a classroom on top of, you  know, your usual workload and so that was a big driver for for us, not to mention the fact that  you know RQI you're doing it quarterly so you get to practice those skills quarterly. And  you know, that's a big deal for a staff nurse or for a clinician who may not see codes on a  regular basis or may not need their CPR skills very often. And so this gave them the opportunity  to practice those skills over and over again, that kind of low dose, high frequency training  and really it just made sense for our health care system to do that. And we implemented RQI in  2017 so we were also kind of those early adopters of RQI and have been using it for quite a while.  Yeah, I do have a question about your experiences and I just got interested with the word "change  agent," and it seems like both of you and your organizations are early adopters and change  agents. And therefore my question is so how did RQI change your organizations or your workflow?  So for us, I'll echo what Dr. Beebe said about that frequent, repeated practice, especially with those  providers that may not be performing CPR on a regular basis, right. That's even more important  in that frequent repeated practice in nursing students who are already novices with BLS, having  that ability to do frequent, repeated practice is pivotal in those students gaining and maintaining  competency of basic life support for us in the health care setting. You know, a big change for  us was the fact that we no longer need to offer all of these BLS courses that we once offered and  our staff don't need to be taken, as I mentioned earlier, away from the bedside for a daylong course  or a half day course or whatever it is. Even when we did you know all online and then you came in  and did your skills it still took people off the units, it took them away from the bedside.  And you know, for us, we have carts throughout the organization so a lot of time we see nurses and  other clinicians you know popping off their unit all day long going to one of the carts, doing their  skills, and hopping right back into patient care, I mean literally feet from where they are taking  care of their patients. So, you know, it was just such a huge change not to mention the fact that  they now feel a lot more confident in at least those basic CPR skills. Yeah, you brought up some  good points because I think about for me, I was an OB so thank goodness I didn't have, I've never done  CPR on an actual person, so I can imagine if I was to go and and practice CPR a year after getting  my card my skills would have decayed. I'm sure I would not be doing my compressions correctly. So I  love the idea of RQI doing that as you mentioned high frequency, you know but low dose. So can you  explain to us those of us that aren't familiar with RQI, what does that look like every quarter?  Like what's being done, what's the amount of time that's needed to kind of do those quarterly  checks? I'm happy to take this one. So we use a learning management system in the hospital  just like you do in the academic setting. We typically use HealthStream but it pops  up on our learning management system portal quarterly. In fact, it feels more frequent at times,  but pops up on our learning management system that we are due for our quarterly RQI and then  there is a very short assessment on online on the computer that you do first or actually you can  do it in any order. But you do an online component and then we go to one of the carts, sign in,  into our account on our learning management system and then the computer is connected to  the manikins and we do an adult and a newborn. You know, we show our CPR skills little more  advanced for, you know PALS and NRP and ACLS, but for the basic life support that's pretty much what  it looks like, takes about 15-20 minutes no more than that and that's including the online portion.  The other important the other thing that I find interesting is that when we answer questions on  the computer or do our skills it asks us how confident are you that you know the answer to  like how confident are you that you know that you did it correctly even without the feedback.  And I think that that's an interesting component to it because you know it can really  show some of those differences in how we think we do and how we actually do, which is cool. And one of the nice things, also once you do those quarterly checks it also extends your CPR  certification by another three months so if you keep up with your quarterly assessments you'll  actually keep on prolonging your certification, which I think is a great added bonus too. Yeah.  I like that idea of not having to go through a lengthy time to just renew your CPR and with  that, I would like to kind of like go back to some of the concepts that I've heard that two of you  say in terms of skills decay. And I think that was from Kellie and I think that's the rationale for  the yes, you can extend your CPR renewal because then your skills have not declined or decayed. So the question that I would like to ask you now is like what did you observe from your learners in  the academic settings and in the hospitals in terms of the skills. What do you measure those  skills or what are the observable changes in your staff or personnel competencies? I'll let Dr. Beebe discuss the clinical skills part of that. For us in our academic setting, it  really changed the way we approached BLS as far as previously, our students we did require them to  have BLS through the American Heart Association, so that part is the same, but it really has  revolutionized the way that we approached that by incorporating it into our curriculum. So the  way that that we decided to implement that was to make it a clinical requirement of our first  semester students in the upper division of our program. During that semester, they have  their first clinical course of health assessment and so we give them clinical time while they're  here in the simulation lab to have time to do that initial test because we talked about the  quarterly update, but we didn't really talk about the initial time commitment for gaining  that initial competency before they go into their into their quarterly. And the advantage to  that is that while it is slightly longer than the quarterly time commitment, it's not much more than  that. It's slightly longer for the online portion. It's slightly longer for the skills portion. But  it's straightforward, to the point, and students are able to do that and still work that into their  clinical time as they're becoming immersed into the nursing curricula, which is helpful to them.  They're already in the lab... It allows them to have access to faculty if they have any  issues or need assistance with that initial certification or using the  skills station, so it really has changed the the way we approach BLS in our curriculum.  It is a part of our curriculum now rather than previously it was a requirement to attend. I love, I love that you just differentiated that that it used to be a requirement and now it's part  of our curriculum, which is so wonderful. In the health care setting, what we have found is that  you know, we can then when we do get our learners in a room together, we can focus on higher level  things. We can focus on team dynamics. We can focus on you know shocking with the defibrillator and  what's a shockable rhythm and things like that instead of focusing all of our time on the BLS  skills. And I will say that RQI does not replace opportunities to practice as a team. You do it  independently, yes, there are scenarios but until you are working as a team you know you still...  it doesn't replace that part... but we have just rolled out mock codes that we run throughout  the entire organization. And what we found was you know, yeah, maybe the BLS skills need a little tweak  here and there or something like that, but for the most part the BLS skills were down  and then we could focus on you know improving shocking within the first two minutes, we could  talk about more nuance things in a code that we may not have been able to do before, and you know  that communication piece, the teamwork, all of that kind of stuff which we know is such a crucial part  to a successful resuscitation and so that's been you know our biggest outcome in our organization  not to mention codes outside the, outside of the ICU are running more smoothly. And I believe  part of that is due to RQI .Thank you for sharing that. So you bring up next question I want to ask  you which is have you had any success stories from people who have taking taken the CPR using the RQI  system? Any aha moments where it it really hit you like oh, this training really does work? Do you have  any of those stories to share? Yeah I do for sure. You know, when nursing students are in clinical  in our facilities if there is a code sometimes it becomes the students need to back away  and let the clinicians who are there be the major participants in a code,  and while that is still absolutely true, we did have a clinical group of a couple of students  who went in to assess a patient during clinical they recognized that the patient was unresponsive  and was pulseless and they began CPR. There were some of their classmates right outside the door.  They were able to alert the staff that there was an issue and then the students were doing a great  job on CPR once the once the staff got into the room and so they allowed the students to continue  doing chest compressions and after that was over the patient went to the ICU. But later  that week when they were in class the students instructor saw me in the hallway going to class  and she stopped me called those students over and they were ecstatic that not only did they get that  experience and they didn't have to leave the room but that they were able to intervene early and  effectively and they were very confident about the skills that they had and they were so proud  of themselves in knowing that they were giving effective CPR. What a beautiful story because,  like you said, so many times when students are in a clinical any emergency happens they're getting  kicked out of the room so the fact that they the nurses came in and they saw them doing a wonderful  job and said continue that. I could definitely see as boosting the students confidence and it had  a good outcome. The person made it and went to the ICU hopefully they left the ICU. But thank you for  sharing that story. That was very impactful. I just got a story today actually. I was so excited. I  was in a meeting and somebody shared a story that I was like, I'm gonna use this this afternoon! But  Kellie, you and I are both women's health nurses by background, and yes, we did not practice CPR  on a regular basis. We knew how to do CPR on a baby, but not on an adult and so a colleague of  mine, a bedside nurse here at our hospital, OB nurse ended up getting rear ended leaving the  hospital a few months ago by a gentleman who was having a cardiac arrest at the wheel.  And so she hopped out and realized that he was in cardiac arrest and started, you know, called  911 but started CPR on him and she tried to get him out of the car but couldn't and so she did  it right there in his seat in the car and and she did it until help arrived. He went to the hospital  and actually she's being recognized in a couple of weeks by our EMS. Our county EMS system they do  a ceremony for survivors and for the the people who saved them and so she gets to be honored at  that. She was telling us this story today but she attributed it to doing RQI because she said, "I'm  an OB nurse we don't do CPR on adults very often." And if ever in our career and but she said but I  knew from RQI what I was supposed to do and so I was able to do it and and save this person, which  is just so cool. Beautiful! Another beautiful story! And perfect timing for our podcast. Yeah, exactly.  And those are amazing stories and to me, while listening to everything that you were saying, it's  really about the patient outcomes in the end, right. Yes, we appreciate that our learners have knocked  that down skills-wise so that they can move on to a higher level of thinking or decision making, but  in the end, like it's really very gratifying to see that what we do, the innovations that we  do as educators, are really impacting lives and patients. That's just amazing to hear. Both of you I would call super users or champions of RQI. Is it a lot of manpower, a lot of work to  get the system up and running and tracking all the learners? How much of your time does it take? From an academic standpoint I would say that it's somewhat minimal. We have a system  administrator who inputs new learners, which for us, that's every semester. And so that probably takes  most of the time, but the students are responsible for uploading certificates and that sort of thing.  For us, I am not the one that manages our RQI. We have a wonderful educator that does and we were  chatting about it earlier today and she was saying the overall lift is not what it was when they  were teaching classes non-stop. You still have to maintain manikins. You still have to maintain  the carts, make sure that they're operational. You know, the company is great about replacing skins  and things like that, but just so people know there is maintenance involved and then also  there's some backend work depending on what type of learning management system you have. It's not  always perfectly seamless from... RQI to learning management system, but what  she said is that, you know, me working a little bit harder versus the satisfaction of our staff  and the competency of our staff staff, you know, the the risk far outweighs the benefit or the benefit  far outweighs the risk with that one. So yeah. There is some backend work to be done. But it's  well worth it, like you said. I mean, when it comes to patient safety and quality of CPR, you can't  even put a number, you know, and measure that. But then on the other end, what you were saying is it  in some ways could be less time consuming than you know, like I used to be a course coordinator of  tracking down people, photocopying, uploading these CPR cards, and also I believe the system will send  reminders too, automatically to the learners to let them know... I'm due next or in a week and a couple of days. So I'm already getting my reminder that it's  time. Well we're going to be getting our system in a couple weeks from Laerdal so we're really excited  because it's perfect timing. My CPR's expired so I can't wait to use it firsthand myself. Any...I know we only have a couple minutes left but I just wanted to end with this last question.  For those out there, whether it's an academic institution or or a hospital medical center who  are kind of thinking about incorporating RQI into their organizations, any tips or pearls of wisdom  that you can give someone who may be thinking about incorporating RQI? So I know one thing that  when we rolled it out the staff were concerned about how much time it was going to take them  because when you say quarterly when it's only been every two years, the immediate thought is taking  the two-year course and applying it quarterly. And it is of course not that, but there can be  push back initially. And so being able to share some of these success stories and explaining to  to staff and you know what it's going to look like for them. I know our hospital took the carts  out to different units, to staff meetings, to things like that ahead of time so that they could see how  easy it was going to be and that in the end it was going to save them time and improve their skills.  And so there may be that concern about that push back, but there are ways of, you know, working  around that. And I'll echo what Sarah said about communication. From an academic standpoint, we make  sure that we tell the students what to expect before we enroll them in RQI, because as Sarah  said earlier, RQI is very, very good about sending reminders and reaching out to to students like  it's an automatic response and so as soon as you enroll those students they will automatically get  an email. And if you have worked with students that are in that first semester where they're  already overwhelmed with information, if they don't know to look for that, they can get confused and  and kind of have a panic moment that they've forgotten something or didn't know about it.  So just that clear communication with students about - you will receive an email about - and just  preventing that confusion if you can. Wow, that 20 plus minutes went by so quickly! I just want to end  by thanking both of you. Thank you for sharing your experiences with RQI and hopefully our listeners  out there learned a little bit more how the system can really improve patient outcomes by, like  you had said, the frequent exposure and deliberate practice of CPR skills that can help prevent, you  know, that decay that happens when you're kind of going two years in between certification. So  thank you so much for sharing all your your wisdom and giving some giving us some tips about the RQI  system. Dr. Bertiz, I don't know if you have any last minute. Yes, I just would like to thank Sarah  and Donna for really sharing your experiences and to me it's like concrete examples of what we  read in research. What we read, what we read about RQI and having the two of you actually give  concrete examples of how it was operationalized and how you saw the outcomes, I really had great  time learning about those. Thank you. And we'll make sure for all our listeners that we include links  to some recent articles that have been published about RQI and also a link so that you can learn  more about the RQI system. Thank you everyone for joining us and we'll see you on our next podcast.[Music]