One Size Doesn’t Fit All: A Unique Ambulatory Care Pediatric Emergency Recognition Program

Background: As health care evolves, more children present for appointments in the ambulatory care setting; some are acutely ill and require rapid assessment and interventions. In our organization, clinical staff are required to maintain CPR certification every two years and receive hands-on emergency training annually to practice emergency response skills in a simulation environment. According to 2015 AHA CPR guidelines, “growing evidence continues to show that recertification in basic and advanced life support every 2 years is inadequate for most people” and “there is an observed improvement in skills and confidence among students who train more frequently.”

Nationally employment of medical assistants (MAs) has increased, and they are frequently the first clinical staff member to interact with patients. Medical assistants have a limited scope of practice and less training to respond to deteriorating patients. A year ago, our organization expanded the scope of practice for medical assistants and made taking the American Heart Association’s Pediatric Emergency Assessment Recognition and Stabilization (PEARS) course within one year required. As MAs began taking the course, instructors and participants reported many not passing without remediation and others not passing after remediation. The ambulatory care nursing leadership team reviewed the feedback and determined it was up to manager discretion to require PEARS and the clinical education team would develop an alternative course.

Objectives: Two objectives were used in developing the alternative course: MAs would be competent in recognizing signs of a deteriorating patient and escalating care in a timely manner, and they would be able to communicate relevant patient history and patient evaluation with nurses and providers clearly and concisely.

Methods: The clinical education team surveyed all MAs in our ambulatory care setting to determine their PEARS attendance/completion, benefits of PEARS, emergency recognition course suggestions, and learning preferences. A few common themes emerged: the PEARS course was focused on nurses, unfamiliar material was delivered too rapidly, and interventions were outside their scope of practice. The MAs found the education and skills they learned in PEARS valuable but preferred a course appropriate for their role. Results also showed many respondents had several preferred learning methods; kinesthetic and visual were the most common.

The clinical educators completed a thorough literature search for existing emergency recognition training for non-licensed caregivers and reviewed the course material for PEARS to determine essential skills for MAs.

Results: The Ambulatory Pediatric Emergency Recognition Program (APERP) was developed. This blended, flexible program is offered in a computer-based format of eight modules and includes written materials available as a quick reference, video demonstrations of skills and equipment, and a graded assessment. Staff receive a survey at the end of the course to assess comfort with emergency recognition skills before and after the course. This program is offered to MAs upon hire and annually.

Conclusion: The APERP trains staff in an accessible format, is relevant to their scope of practice, and highlights skills needed in our environment. This program, paired with existing hands-on emergent training, leads to competent, confident medical assistants caring for deteriorating patients in the ambulatory care setting.