A New Approach to Emergency Code Blue Training

1. A New Approach to Emergency Code Blue Training MARIELLA A. WHILE, RN, BSN, MED MARY KAY LOYD, RN

2. Conflict of Interest • We have no conflicts of interest to diclose

3. A New Approach to Emergency Code Blue Training Seeking Mastery Multiple approaches and buy in Results

4. Where Are the Pitfalls? • Education • Psychomotor Skill Gap • Cognitive Knowledge Gap • Defibrillator • Psychomotor Skill Gap • Cognitive Knowledge Gap • System

5. Pitfalls in the Education Process • Pitfalls leading to program development • Collaboration with Code Blue Committee • Need to reinforcement the primary survey with the staff • BLS Training

6. Pitfalls With the Defibrillator • What contributes to delays? • Staff policies • AED function of defibrillator unknown • Placing EKG leads • Connecting defibrillator • How often do we reanalyze and shock?

7. Pitfalls With the In-House System What contributes to delays? • Supplies • Pagers • Paging delays • Delay in team arrival

8. What was Happening in House? • Rapid Response activation=decreased Code Blue rates • Decreased experience with activating and responding to a Code Blue • Staff participation in codes was estimated 1 every 5 years • New BLS /ACLS guidelines • Standardize a system for ACLS and BLS programs • Inconsistent training

9. Desired Outcomes • Reduce time from discovery to defibrillation to 3 minutes • Improve performance as a team at the bedside • Improve system barriers

10. Essential elements of success • Champions • Code Blue Committee Chair • Clinical Nurse Liaison/Clinical Nurse Specialist • Clinical Simulation Center Staff

11. Where do we train? • In Situ • Empty patient room • Hallway • Clinic room • Garage • In the Clinical Simulation Center • 6 individual rooms

12. Methodologies • PROGRAMS • DEBRIEF • MNEMONICS • REPETITION

13. Programs in Place to Improve Pitfalls

14. “CCC,ABC,123” Mnemonic • Break the BLS survey down in a way the participants can remember • Desire a visual aid • Frantically write it down • Musical

15. Mnemonics Work • BLS Primary Survey: CCC, ABC,123 • Check • Call • Care • Airway • Breathing • Circulation • 1-Turn defibrillator on • Pads placed/ connected • 2-Analyze • 3-Shock if advised

16. Code Blue Readiness • Goal: • Improve primary survey • Promotes proper use of equipment • Improve code blue discovery to defibrillation times • Build confidence in nurses and techs • Improve performance as a team at the bedside • Addresses both educational and defibrillator pitfalls

17. How do we do it? Code Blue Readiness • Started as: • Prep for residents rotating into code blue team • Scheduled champion faculty biweekly • 1 hr. algorithm review – minimal on BLS survey • Champion faculty evaluation vtach>vfib>PEA • Code Blue Practice for team training

18. How do we do it? Code Blue Readiness • Evolved to: • Focus on the BLS process for nurses and techs throughout the hospital • To the sim center for training

19. How Do We Do It? Code Blue Readiness • Schedule: • Preregister for a session through SITEL's Learning Management System • Not limited • Bimonthly for a hour • Tools: • “CCC, ABC,123” • Human patient simulator • Drug box, BVM, defibrillator and pads

20. Code Blue Readiness Process Code Blue Readiness • The Process • BLS primary survey review using the mnemonic “CCC, ABC,123” on a human patient simulator • Put it all together! • Hands on practice moving through the BLS Primary Survey for 10 minutes • Coaching environment • Debrief

21. Teaching Using the “CCC,CAB,123” Mnemonic Code Blue Readiness • Check for responsiveness, breathing, movement • Call for help, AED • Care • Airway • Head tilt/chin lift • Breathing • Use of BVM-technique • Circulation • Assess-0 pulse + 0 breathing=CPR Why VS? Call a code! • CPR- technique- Harder& faster 100x/minute, 2 inches • 1 • Turn it on • 2 • Analyze mode • 3 • Shock if indicated- • Resume CPR- 2 minute cycle

22. Mini Code Blue In SituCode Blue Challenge • Goal: • Improve all around performance as a team at the bedside • Improve code blue discovery to defibrillation times • Improve primary survey process • Build confidence in nurses and techs • Promotes proper use of equipment • Addresses both educational and defibrillator pitfalls

23. How we do it? Mini Code Blue In Situ • Started as: • Difficult for staff to come off unit for an hour to attend the Code Blue Readiness Class • Defibrillator training on the individual units didn’t happen • In Situ-we went to them • Schedule: • Limited to once per week + blitzes • Prearranged date and time with unit director • No bed- conduct session in gym, hallway • Tools: • “CCC, ABC,123” • Human patient simulator • Drug box, bvm, defib pads and unit defibrillator

24. The Process Mini Code Blue In Situ • Roll onto the unit with the human patient simulator • AA at the front desk is informed not to call the code overhead • Staff member gets a sim brief and is asked to come see a patient brought up from the ER who “doesn’t look good” • Allow them to move through the BLS Primary Survey timed by team • Nurses and techs arrive from the unit in response to the call for help. • Ready? Go/No Go by educator • Educator steps in as a team leader to move further through the code. • Debrief

25. Debrief using “CCC,ABC,123” Mnemonic Mini Code Blue In Situ • Check for responsiveness, breathing, movement • Call for help, AED • Care • Airway • Head tilt/chin lift • Breathing • Use of BVM-technique • Circulation • Assess-0 pulse + 0 breathing=CPR Why VS? Call a code! • CPR- technique- Harder& faster 100x/minute, 2 inches • 1 • Turn it on • 2 • Analyze mode • 3 • Shock if indicated- • Resume CPR- 2 minute cycle

26. Keeping track Mini Code Blue In Situ • Data sheet for each of the 2 simulation staff trained in this area • Sign in • Data entry

27. Resident Code Blue Refresher • Goals: • Improve performance as a team at the bedside • Improve code blue discovery to defibrillation times • Addresses both educational and defibrillator pitfalls

28. How Do We Do It? Resident Code Blue Refresher • Started as: • Code Blue Readiness • Evolved to: • Current Course-preregister • Prep for 10-15 residents carrying the code pager • Focus not as broad

29. How We Do It (continued) Resident Code Blue Refresher • Schedule: • First Friday of the Month for a hour in the Clinical Simulation Center • Tools: • “CCC, ABC,123” poster • Megacode poster • Human patient simulator • Drug box, BVM, defibrillator and pads

30. Where Do I Start When I Am the Team Leader? Resident Code Blue Refresher • Communication- The door swings both ways • Is the CCC, ABC,123 in place? • High Quality CPR? • Ventilations effective with the BVM? • Pads on chest, connected, and rhythm analyzed? • What mode are you in on the defibrillator? • Roll into algorithm

31. The Process Resident Code Blue Refresher • BLS primary survey • “CCC,ABC,123” • Tying the programs together • ACLS • Algorithms • Put it all together! • Group performs CPR, ventilates with BVM, hands on practice with defibrillator, opens and gives drugs. • Coaching environment- fun and energetic • Debrief • Team Lead is a tough job!

32. Code Blue In Situ • Goal: • Improve all around performance as a team at the bedside • Build confidence and collaboration amongst all members of the code team • Improve code blue discovery to defibrillation times • Improve primary survey process • Promote proper use of defibrillator • Addresses educational, defibrillator, and system pitfalls

33. How Do We Do It? Code Blue In Situ • Started as: • Monthly In Situ • Evolved to: • Weekly In Situ • Schedule: • Prearranged Dates • Random bed assignment • Tools: • Human patient simulator • Unit crash cart, defibrillator, pads, BVM • “CCC, ABC,123” poster

34. The Process Code Blue In Situ • Surprise! • Staff member gets a simulation brief • BLS Primary Survey timed by team • Code is called overhead • Debrief

35. Collecting the Data Code Blue In Situ • Data sheet for Code Blue Committee chair • Data sheet for each of the 2 simulation staff well trained in this area • Sign in • Data entry

36. Debrief of the Team Self Evaluation of the team Breakdown of the InSitu by Sim team System challanges Lessons Learned Where did we do well? Where can we improve? Did we reach the AHA goal of 3 minutes from time of discovery to the first defibrillation? Education Code Blue In Situ

37. Closing the Gap

38. More Than One Approach Code Blue In Situ • Recertification 2 years • Not enough • Multiple programs needed to practice skills in order to retain knowledge • Collaborative approach to training • Breaking the Silos • Frequency of In Situ • Increasing requests for practice and training in activating and responding to a code blue with a real life response. • Feel of the session • Coaching with education • Just in time training • After In Situ training

39. Just In Time Team Training

40. On The Horizon • Continue our programs to further close the gap towards AHA goal of 3 minutes • Continue our programs with utilization of new BLS & ACLS guidelines • System wide initiative to promote code blue response • Formal research

41. Thank You! Questions?

42. Feel Free to Contact Us • Mary Loyd, RN, Clinical Simulation Educator • Office Phone: 202-877-3217 • Email:mary.loyd@email.sitel.org • Mariella While, RN, BSN, Med, Senior Clinical Simulation Educator • Office:202-364-5180 x 143 • Email:mariella.while@email.sitel.org