Transcript Mock Codes: Two years in review

Paris Hotel and Casino  Las Vegas, Nevada
Mock Codes Lead to real
Results
Presented by:
Bridgid G. Joseph BSN, MSN, CCNS
Presenter Disclosure
Information
Bridgid G. Joseph
Mock Codes Lead to Real Results
FINANCIAL DISCLOSURE:
 No relevant financial relationship (s) exist
If you don’t use it, you
lose it
• 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
Background
• Created a New Formalized Mock Code
Program:
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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
Intervention
• Start with an unresponsive patient
• Training Code cart available at site
• Fully stocked mimicking our code carts
• Training medications/bristojets used.
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Patients in a shockable rhythm
• VFib, pulseless VTach
Mock Code Details
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Recognition of Arrest
Position of bed and patient
CPR
AED
Code Cart
Emergency Medications
Debrief
Mock Code Details
• 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
Expansion of Focus
2011 Results
3:40
2:35
0:40
Results 2011
Time to CPR
(minutes)
Time to
Defibrillation
0:00
Time to Epinephrine
Time to 1st
Responder
2011 Results
100.0%
85.7%
61.9%
59.5%
50.0%
50.0%
47.6%
14.3%
16.7%
2012 Results
4:00
Adjusted for time to first
responder
2:45
0:50
Time to CPR
(minutes)
0:50
Time to Defibrillation Time to Epinephrine
Time to 1st
Responder
2012 Results
94.2%
74.3%
65.7%
59.4%
42.3%
20.0% 24.2%
11.4% 11.4%
2013 Results
4:30
Adjusted for time to
first responder
3:10
1:50
1:35
Time to CPR
(minutes)
Time to Defibrillation Time to Epinephrine
Time to 1st
Responder
2013 Results
100.0%
83.9%
74.0%
61.8%
45.5%
30.3% 32.1% 32.1%
18.1%
2014 Results
4:10
Adjusted for time to
first responder
2:35
1:10
0:47
Time to CPR
(minutes)
Time to Defibrillation Time to Epinephrine
Time to 1st
Responder
2014 Results
96.2% 93.3%
67.9%
50.0% 53.6%
19.0%
41.4% 41.4%
27.6%
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Time
Staff buy-in
Increased Census
Alarm Fatigue
Staff recognition
Off Shifts
Pitfalls
4:19
3:50
3:21
2:52
2:24
2011 Results
2012 Results
1:55
2013 Results
1:26
0:57
0:28
0:00
Time to CPR
(minutes)
Time to
Defibrillation
Time to
Epinephrine
Time to 1st
Responder
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:
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Staff report feeling more confident
Working better as teams
Asking for mock codes
Sneers have turned to cheers!!
Conclusion