Purpose

1. Use of Mock Code Simulation in the Development of Competence, Communication and Confidence in Actual Code Situations among Staff in the Michigan Congenital Heart Center J Augustine RN, MSNEd, C Angelocci RN, BSN, D Hardenbrook RN, BSN, D Roberts RN, MSN, C Ziolkowski RN, BSN, M McReynolds RN, MS, EMT-P A Armstrong MD, C Goldberg MD Results Purpose Summary from Mock Code Survey May 2010 to May 2011 The goal of our program was to achieve optimal multidisciplinary team performance during actual patient arrests in the Pediatric Cardiothoracic Intensive Care Unit (PCTU) and 5 East Mott through the use of mock code simulations. Objectives developed included: • Improve competence of team: • Use of PALS algorithms • Use of population specific scenarios • Increase comfort with equipment • Improve communication among team members: • Identification of the leader • Sharing observations and suggestions • Clarifying orders • Stating when interventions were needed, ordered and completed by using closed loop communication • Increased confidence: • Through simulation practice with the team It was hypothesized that improving the teams competence, communication and confidence during actual arrests would lead to improved patient outcomes. • 87.2% of the staff in June 2011 felt a little comfortable to very comfortable with arrest situations compared to 78.5% in May of 2010 • Suggestions for improvement from the survey in May 2010 to June 2011 has progressed from becoming familiar with equipment and roles in arrest situations to remaining calm, using clear, closed loop communication, debrief following all arrests and providing arrest education to all new staff Methods Post Arrest Evaluations A pre Mock Code Survey was sent out to medical and nursing staff of PCTU and 5 East to determine their comfort level, experience and expectations in arrests situations. Following the survey a schedule was formed to conduct simulation arrests in both units 2 to 6 times per month for 1 year. Population specific scenarios were created and used . Nurses, fellows, residents, nurse practitioners, respiratory therapyand pharmacy were invited to participate. The staff in the simulation lab conducted the mock arrests using a simulation baby and physiological monitor, with the “patient” responding to interventions performed by the team. A debriefing followed to identify areas of strength and improvement. Following patient arrests on PCTU and 5 East debriefings and/or evaluations were completed to assess the teams performance. A post Mock Code Survey was repeated after 1 year to reassess the teams comfort, experience and expectations during arrests situations . Conclusions/Impact Staff identified these key areas for improving performance during an arrest situation: Identification of the leader Use of closed loop communication Understanding of everyone’s roles Value in debriefing following arrests Background PCTU and 5 East Mott experience the majority of patient arrests in Mott. Patients in these areas have unique cardiac physiology. Appropriate treatment, interventions and patient outcomes depends on the teams understanding of the patients underlying cardiac condition. Identified areas for improvement included: • Teamwork • Communication • Familiarity with arrest equipment • Interventions for specific physiology References Arx, D. & Pretzlaff, R. (2010). Improved nurse readiness through pediatric mock code training. Journal of Pediatric Nursing, 25(5):438-440. Gilfoyle, E., Gottesman, R., & Razack, S. (2007). Development of a leadership skills workshop in paediatric advanced resuscitation. Medical Teacher, 29: 276-283. Keys, V., Malone, P., Brim, C., Schoonover, H., Nordstrom, C. & Selzler, M. (2009). Code carnivals: Resuscitating code blue training with accelerated learning. The Journal of Continuing Education in Nursing. 40 (12): 560-564. Mikrogianakis, A., Osmond, M. H., Nuth, J. E., Shephard, A., Gaboury, I., & Jabbour, M. (2008). Evaluation of a multidisciplinary pediatric mock trauma code educational initiative: A pilot study. Journal of Trauma, 64, 761-767.