Mock Codes Lead to real Results

Paris Hotel and Casino Las Vegas, Nevada

Presented by:Bridgid G. Joseph BSN, MSN, CCNS

Presenter Disclosure Information

Bridgid G. JosephMock Codes Lead to Real Results

FINANCIAL DISCLOSURE: No relevant financial relationship (s) exist

If you don’t use it, you lose it

Background

• Previous mock codes on units lasted over an hour• Simulation Center: 3 hour mock code team

training monthly• Fewer actual Code Blue events within our

hospital

Intervention

• Created a New Formalized Mock Code Program:• 1 mock code on each unit monthly• All unannounced to floor staff• Covered all shifts• Mock codes consist of a training and debrief • Last a total of 10 minutes• Focused educational exercise

Mock Code Details

• Start with an unresponsive patient• Training Code cart available at site• Fully stocked mimicking our code carts• Training medications/bristojets used.

• Patients in a shockable rhythm • VFib, pulseless VTach

Mock Code Details

• Recognition of Arrest• Position of bed and patient• CPR• AED • Code Cart • Emergency Medications • Debrief

Expansion of Focus

• Able to assess other hospital-wide initiatives during the response to these exercises: • Alarm Fatigue: Staff response to low level

telemetry alarms (leads off alarms)• Hand hygiene: ensure all secondary responders used

cal STAT, gloves, appropriate PPE• Teach code cart/code team policy changes during

debrief• Team training: working together and

communicating

Results 2011

0:40

2:35

3:40

0:00

2011 Results

Recog

nitio

n of A

rrest

Initi

ation

of E

mer

genc

y Res

pons

e

Bed in

Pos

ition

CPR Initi

ated P

rope

rly?

Code C

art U

sed?

AED Use

d?

Safety

Item

s Loc

ated i

n Cod

e Car

t?

Med

icatio

ns L

ocate

d?

100.0%

85.7%

50.0%59.5%

14.3%

47.6%

16.7%

61.9%50.0%

2011 Results

Time to

CPR (minutes)

Time to

Defibrillation

Time to

Epinephrine

Time to

1st Resp

onder

0:50

2:45

4:00

0:50

2012 Results

Adjusted for time to first responder

Recognition of A

rrest

Initiation of Emergency

Response

Bed in Positi

on

CPR Initiated Properly

?

Code Cart Use

d?

AED Used?

Safety

Items L

ocated in

Code Cart?

Medications L

ocated?

94.2%

74.3%

42.3%

65.7%

20.0% 24.2%11.4% 11.4%

59.4%

2012 Results

Time to

CPR (minutes)

Time to

Defibrillation

Time to

Epinephrine

Time to

1st Resp

onder

1:50

3:10

4:30

1:35

2013 Results

Adjusted for time to first responder

Recognition of A

rrest

Initiation of Emergency

Response

Bed in Positi

on

CPR Initiated Properly

?

Code Cart Use

d?

AED Used?

Safety

Items L

ocated in

Code Cart?

Medications L

ocated?

100.0%83.9%

18.1%

61.8%45.5%

30.3% 32.1% 32.1%

74.0%

2013 Results

Time to

CPR (minutes)

Time to

Defibrillation

Time to

Epinephrine

Time to

1st Resp

onder

1:10

2:35

4:10

0:47

2014 Results

Adjusted for time to first responder

Recognition of A

rrest

Initiation of Emergency

Response

Bed in Positi

on

CPR Initiated Properly

?

Code Cart Use

d?

AED Used?

Safety

Items L

ocated in

Code Cart?

Medications L

ocated?

96.2% 93.3%

19.0%

50.0% 53.6%

27.6%41.4% 41.4%

67.9%

2014 Results

Pitfalls

• Time• Staff buy-in• Increased Census• Alarm Fatigue• Staff recognition• Off Shifts

Time to

CPR (minutes)

Time to

Defibrillation

Time to

Epinephrine

Time to

1st Resp

onder0:00

0:28

0:57

1:26

1:55

2:24

2:52

3:21

3:50

4:19

2011 Results2012 Results2013 Results

Conclusion

Overall a successful program: • Improvements:

• Significant improvement in overall code cart knowledge, use of AEDs, and medication location and use.

• Staff starting CPR immediately, able to defibrillate quickly, and have epinephrine ready and administered quickly.

• Anecdotally: • Staff report feeling more confident• Working better as teams• Asking for mock codes• Sneers have turned to cheers!!