Saving Patient Ryan: using in situ simulation to improve code blues

Presentation Abstracts from 2012 INACSL Conference e404

came monthly to each designated unit and scored them on their timing and

performance of high quality BLS skills.

During the threemonthswe have started ourmock code training, we found

the following implications and conclusions: We changed the name from

mock code training to ‘‘first responder training’’, we saw scores on unit

evaluations rise from45%to 85%andmostly after the training in the area that

had the biggest need, the team had started compressions, had the pads placed

on correctly and was performing effective compressions during their next

cardiac arrest. That patient had lived too by the way!

We are nowgoing to use our ECS simulator to test outwith their BLS skills

where deemed necessary. This higher fidelity simulator model can show the

performer that success more so with displaying the systolic blood pressures

with their compressions.

Evaluating and Obtaining Annual Competencies Utilizing Simulation inPediatric Intensive Care

Level of Presentation: Novice

Randall Stennett, MSN, RN, Covenant Health System, Covenant School

of Nursing, Texas Tech University Health Sciences Center, West Texas

Simulation Alliance; all located in Lubbock, TX; 806-725-0295,

rstennett@covhs.org

Shannon Shuttlesworth, MSN, RN, Gwen Davis, MSN, RN, and Sharon

Decker, PhD, RN

Objectives:

1. Discuss the process of designing and conducting a simulation-basedcompetency assessment for pediatric intensive care.

2. Relate associated findings both expected and unanticipated from a sim-ulation-based competency assessment for pediatric intensive care.

Background: The Joint Commission (JCAHO) stated in standardHR1.06.01staff should be competent to perform their responsibilities and suggestedsimulation may be used to show this competence. Simulation-based traininghas demonstrated improved outcomes in high-risk situations, reduced cost,and decreased mortality (Cross & Wilson, 2009).

Purpose: A pilot project was initiated in an 18 bed PICU to evaluate nurses’competenciesusing simulation.Competencieswere selectedbasedon staff needsassessment and a root-cause-analysis of critical incidents occurring over a 12month period. These competencies included; IV starts, IO insertions, EKGinterpretation, airwaymanagement (especially related to unplanned extubation),and communication (among teammembers). Staff were provided an orientationto the simulator andopportunities forpracticeprior to thecompetencyassessmentweremade availablewithin the unit. Scenarioswere developed based on realisticsituationandhospital quality indicators.Anexpert panel reviewedall scenarios tosupport reliability and validity. All simulations were conducted within thepediatric intensive care unit and lasted 20 minutes followed by debriefing.

Methods: This descriptive, quasi- experimental study was a one-groupdesign in which participants served as their own controls. Measurementsincluded changes in learner self-efficacy as reflected on the difference frompre-to post scores using the Learner Self-Efficacy Scale. Individual decision-making scores were determined using the Lasater Clinical Judgment Rubicand knowledge levels were reflected through a multiple choice examination.

Findings: Data analysis revealed a decrease in post-simulation self- evaluationfor self-efficacy and a direct correlation identified between experience in PICUand clinical judgment reflected in the Lastater Clinical Judgment Rubic. TwounexpectedLatentThreats toPatientSafety (PTS)were identifiedandcorrected.

Conclusion: Simulation-based competency testing utilizing a validated toolprovided objective data for performance evaluation that was positivelyreceived by the staff. Follow-up over the past 10 months has demonstrateda significant decrease in unplanned extubation.

Saving Patient Ryan: using in situ simulation to improve code blues

Level of Presentation: Novice

Heidi Traxler, MSN, RN, Clinical Simulation Supervisor, Providence

Little Company of Mary Medical Centers, 4101 Torrance Boulevard

Torrance, CA 90503, (310)-303-5567, heidi.traxler@providence.org

pp e385-

Melissa Punnoose, MSN, RN-BC, Clinical Educator: Simulation,

Providence Little Company of Mary Medical Centers

Objectives:

1) Following the presentation participants will understand how in situsimulation can be utilized for research and education in their ownpractice setting.

2) Describe how in situ simulation can be used to improve code blueeducation.

Background: Timely resuscitation efforts are critical to survival whena patient codes. Feedback from respiratory therapists, ICU charge nurses,and emergency room physicians indicates that when the code blue teamarrives resuscitation efforts are not always in progress, a clear leader is notestablished, and clear communication does not always occur. BiannualrecertificationofBLSandACLShasnot been sufficient to ensure efficiencyofcode blue responsiveness. Neither have annual code blue simulation events. Itis necessary, therefore, to implement another form of training. The objectiveof this study is to determine whether frequent in-situ simulated mock codeblues in themedical surgical and telemetry areas will improve responsivenessand effectiveness of healthcare providers in a code blue situation.

Methods: Prior to starting the simulated mock code blue events, code blueteam members were surveyed in regards to the current state of mock codeblue responsiveness. The in situ mock code blues, using a mid-fidelitymannequin, were offered twice a week on four medical surgical andtelemetry units over a six month period from October 2011 through March2012. Theywere held on both the day and night shifts. Eachmock code lastedless than 10minutes, including debriefing, in order to respect the nurses’ timeand to make patient safety on the units the priority. The focus of the mockcodes was on early initiation of CPR, readiness for defibrillation within twominutes, leadership, and communication.

Findings: Through observation of in situ code blues and feedback from codeblue teammembers and RNs from pre and post study surveys and from actualcode blue experiences our objectives are to: 1) Improve timeliness of CPRinitiation 2) Decrease time for readiness to defibrillate 3) Improve commu-nication and leadership in codes. We have already received feedback frommed surg telemetry RNs that the in situ codes are valuable and should be donemore often. Nurses who have participated in two ormoremock codes are nowable to identify priorities, assume leadership, and prepare for defibrillation inunder two minutes. After starting the in situ mock code blues we receivedfeedback froman anesthesiologist who frequently responds to codes about theeffective, coordinated efforts during a recent resuscitation on a telemetryfloor.

Conclusion: Through regular participation in in situ mock code blues,Registered Nurses will feel more confident in participating in resuscitationefforts andwill show improved timeliness of initiationofCPR, decreased timefor readiness to defibrillate, and improved communication and leadership.

Relevance to the conference theme: This presentation is relevant becausein situ simulation and research demonstrate a new direction for oursimulation center. Additionally, while in situ simulation is a tried and truemethodology, it is underutilized in the practice setting.

Energizing Returning Nurses to Clinical Practice Utilizing SimulationExperiences

Level of Presentation: Novice

Penni Watts, MSN, RN, Director of Clinical Simulation and Training,

University of Alabama (UAB) Learning Resource Center, Birmingham,

AL, 205-934-6560, piwatts@uab.edu

Nanci Swan,MSN, RN, Instructor, UAB School of Nursing, Birmingham AL

Objective: The purpose of this presentation is to discuss how clinicalsimulated experienceswere used to enhance a hospital based course designedfor updating returning nurses on nursing concepts in preparation forreintegration into the nursing workforce.

Background: In light of the economy and the nursing shortage, registerednurses who have been out of practice for an extended period, are workingtowards re-entry into the clinical nursing arena. With the rapidly changinghealthcare arena, nurses must be prepared and ready to enter a complex andfast paced environment and be able to adapt and quicklymanage patient care.

e416 � Clinical Simulation in Nursing � Volume 8 � Issue 8