Transcript (PCTU) and 5 East Mott through the use of mock code simulations

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.
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
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
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 .
Post Arrest Evaluations
5 East Arrest Evaluations
May thru October 2010
Scale Used
MD in charge clearly identified self as leader:
MD in charge used clear concise communication
with the team:
MD was able to anticipate, assist and carry out
appropriate interventions according to the patients
response:
The bedside nurse identified herself and was able to
use clear communication to the team in relaying the
patient’s history and events leading up to the arrest:
The bedside nurse was able to anticipate, assist and
carry out appropriate interventions according to
the patient’s response:
The cart nurse was able to locate supplies and
equipment needed:
Recorder communicated and confirmed
medications, interventions and rhythm analysis
with team
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 .
3.5
N=16
3.8
N=7
3.6
N=14
3.5
N=7
3.2
N=13
3.2
N=12
3.6
N=6
3.2
N=5
1= Poor
2= Fair
Overall team performance
Belief that participation in Mock Codes increased
your confidence, communication and competence in
this code situation.
3.2
N=16
2.9
N=16
3.7
N=12
2.8
N=8
2.8
N=8
3.4
N =6
Oct/Nov 2010
3=Good
4=Excellent
3.3
N=9
3.3
N=9
3.6
N=9
3.4
N=9
MD’s/RN’s please evaluate RN’s on the following:
Organization
Communication
RN’s please evaluate MD’s:
Organization
Clear concise communication with team members
Overall organization of arrest
Nurses, fellows, residents, nurse practitioners, respiratory
therapy and pharmacy were invited to participate.
3.4
N=16
3.4
N=18
3.5
N=16
November 2010 thru April
2011
3=Good
4=Excellent
3.6
N=6
3.6
N=7
3.8
N=6
PCTU Arrest Evaluations
Aug/Sept 2010
Scale Used
1=Poor
2= Fair
RN/MD’s evaluate charge nurse in relation to:
Facilitated clear, concise communication with team
3.8
members
N=6
Anticipated problems and orchestrated timely and
3.8
accurate responses
N=6
Demonstrates team leadership during crisis
3.8
management
N=6
Demonstrate comfort in voicing concern during
3.8
team interaction and crisis management
N=6
Anticipated problems and orchestrated timely and
accurate response
Were Roles executed effectively and efficiently?
Do you feel Mock codes have increased your
confidence in performing code roles?
3.8
N=7
3.5
N=7
3.7
N=10
3.3
N=10
4
N=7
4
N=7
3.7
N=7
3.8
N=7
3.8
N=7
3.8
N=9
3.6
N=8
3.8
N=8
3.6
N=8
3.5
N=8
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
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.