Mock Codes Lead to real Results Paris Hotel and Casino Las Vegas, Nevada Presented by: Bridgid G....
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Transcript of Mock Codes Lead to real Results Paris Hotel and Casino Las Vegas, Nevada Presented by: Bridgid G....
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!!