Restructuring of a Code Blue Team Focus on Outcomes Measures:

1. Restructuring of a Code Blue Team Focus on Outcomes Measures: Use of a CQI Approach Shannon Johnson, RN Deaconess Hospital Evansville, IN

2. Authors Shannon Johnson, RN Maria Shirey RN, MS, MBA, CHE, CNAA Lynn Schnautz RN, MSN, CCRN Jean Hunt RN, BSN, BC Sandy Duvall RN, BSN, CCRN

3. FADE

4. Focus Present State: • The Code Blue Committee (CBC) began mid 1970s. • Responsible for policies & evaluation of documentation • Staff unaware of what the CBC was doing. • Data collection and reporting • Impacting practice and patient outcomes.

5. Focus Current problem/Situation: • Questions regarding the role and purpose. • Staff verbalizing insecurities. • Outcome data unavailable • Dated and non standardize crash carts. • Educator’s assessment

6. Analyze • What is the actual and perceived effectiveness of the CBC? • A survey was distributed. • How effective is the Code Blue Response? • Audit tool was developed for the ADONs • What data is required to measure patient outcomes? • Literature search was conducted. • Automated data collection systems were reviewed

7. Survey Results Low staff proficiency Increased anxiety of staff Disorganized response Physician Satisfaction Incomplete forms Lack of quality outcomes Desired State Proficiency with delineated roles Decreased staff anxiety Organized response Increased physician satisfaction Completed documentation Outcome based information Analyze

8. Analyze An opportunity exists to improve the perceived and actual effectiveness of the CBC in the patient care process beginning prior to the initial code blue event and ending with the patient’s discharge from our institution. This portion of the process currently causes stress, confusion, and negative outcomes both actual and perceived. These outcomes are primarily demonstrated in the form of lowered staff proficiency, physician satisfaction, team work, and outcomes. Improvement of the process by addressing and correcting actual and perceived effectiveness of the CBC will create superior patient care resulting in increased staff proficiency, decrease staff stress, increase physician satisfaction, improved team work, and measured outcomes. Our relentless pursuit of excellence will result in measurable patient care outcomes and improved patient outcomes.

9. Develop The Game Plan • Restructure CBC • Establish indicators to monitor quality outcomes • Revise policies and procedures • Develop a coordinated response team with established roles • Designate subcommittees

10. Execute • Reorganized entire CBC based on survey results. • Appointed new multidisciplinary CBC with new chairperson. • Established facilitator role within CBC. • Established five subcommittees: • Public relations • Policies and Procedures • Education • Audits • Equipment

11. Execute Public Relations • 90 day action plan was developed • Action plan targeted the following key strategies: • Published survey results • Distributed heart shaped cookies • Developed display in lobby • Awarded door prizes

12. Execute Policy and Procedures • Identified designated roles and patient care areas responsible for key roles. • Key roles: • Code Blue Coordinator CVICU (Cardiovascular ICU-2900) • Medication Nurse NMSICU (Neuro Medical Surgical ICU-3900) • Documentation Specialist CVCC (Cardiovascular Care Center-2500/2600) • Reviewing and revising P&P related code blue events

13. Execute • Educators for each response role. • BLS and ACLS training. • Mock code blue drills and critiques. • Communication notebook for code blue responders. • New standardized equipment. • Crash cart displayed on the intranet and distributed posters. Education

14. Execute Audits • Reviewed and critiqued forms completed by the ADONs • Improved CPR data acquisition, interpretation, and entry. • American Heart Association National Registry of CardioPulmonary Resuscitation (AHA NRCPR) • Beeper to track all code events. • Quarterly code blue outcome reports.

15. Execute Equipment • Distributed new crash carts • Reviewed and modified equipment and supplies • Developed defibrillator replacement plan. • Revised daily defibrillator discharge checklist.

16. Outcome Indicators • Effect patient outcomes. • 100% code blue charts audited. • Benchmarked with American Heart Association Registry

17. Initial Rhythm VT/VFTime to First Defib

18. Initial Rhythm PEA/AsystoleTime to First Epi

19. Respiratory Arrest to Intubation

20. Percent of Code Blues Outside the ICU

21. Code BlueSurvived EventSurvived to Discharge

22. Summary • Initial survey results: • Decreased staff proficiency • Increase staff anxiety • Decreased physician satisfaction • Incomplete documentation • Lack of outcome measures • Outcomes: • Proficient staff with 3 delineated roles • Decrease staff anxiety and increase physician satisfaction • Complete documentation of code blue event • Outcome measures

24. Questions