Purpose: In a quaternary level, Magnet-designated teaching hospital where patients’ acuity is high on general medical and surgical units, patients’ conditions could deteriorate quickly. Responding to a code is a low frequency but a high-risk skill. Literature states confidence in performing effective basic life-support skills declines if not used regularly. Team dynamics play an important factor in patient outcomes. Nurses on 9 medical and surgical units (including float pool) voiced concerns that their comfort level was not where it needed to be during a code. The units’ leadership teams verbalized the need to conduct mock codes based on feedback/observations during a code. Educators recognized the need and provided a unique, innovative, and collaborative approach to facilitate increase retention and comfort levels of required skills set during a code blue
Description: All staff involved in the pilot had completed BLS provider course within the last 18-24 months. An innovative approach to validating basic life support was developed and implemented. Three professional development educators of the said units worked as a team. An interdisciplinary multiple-unit approach was utilized. An electronic sign-up process was distributed to 517 bedside leaders, including nurses and unlicensed personnel. 34 sessions were offered to accommodate different shifts. Staff were able to select a date and time to attend that was convenient for them. Staff were able to choose various roles associated with code scenarios. Roles included team leader, compressor, airway, medications, and recorder. The group was divided into two. A sense of competition between the groups was palpable. The first group responded to the code while the second group observed. Debrief occurred post-scenario on what went well and what could have been done better. This created dialogue around team dynamics in staff from various units. Then the second group responded to the code and applied lessons learned from the first group. Pre- and post-surveys were distributed prior to and upon completion of the 30-minute session. Survey questions addressed confidence in BLS skills, use of AE and bag valve mask correctly; familiarity with the crash cart; and overall value of experience.
Evaluation/outcome: Pre- and post-surveys resulted in a very significant increase in confidence of BLS skills, use of AED, and bag valve mask correctly, and familiarity with the crash cart. Overall value of experience was significantly high. The majority of the time the second group performed very well compared to the first group. Team support increased among the various units. Qualitative data revealed an interdisciplinary multiple-unit format was “a great refresh and will help all member involve.” Feedback received from unit leaderships as well as the nursing house supervisor after a patient coded regarding staff performance on two code blues states: “The staff did really well.” One bedside leader made a comment right after a code blue on her unit that “If I had not been to a mock code, I would have scrambled.”
After completing this learning activity, the participant will assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
BSN, RN, CMSRN,
Professional Development Educator,
Baylor University Medical Center at Dallas