Implementing an in Situ Mock Code Quality Improvement Program

Abstract

BackgroundThe high risk and low volume of medical emergencies, combined with long periods between training sessions, on 2 progressive care units at Mayo Clinic, Rochester, Minnesota, established the importance of transforming how nursing staff are trained to respond to medical emergencies. Objectives To increase confidence levels and improve nursing performance during medical emergencies via in situ simulation. Methods An in situ, mock code quality improvement program was developed and implemented to increase nurses' confidence while improving nursing performance when responding to medical emergencies. For 2 years, each unit conducted mock codes and collected data related to confidence levels and response times based on the recommendations in the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Results In those 2 years, nursing staff response times for calling for help improved 12%, time elapsed before initiating compressions improved 52%, and time to initial defibrillation improved 37%. Additionally, staff showed an increase in perceived confidence levels. Staff reported their appreciation of the opportunity for hands-on practice with the equipment, reinforcing their knowledge and refining their medical emergency skills. Conclusions In situ mock codes significantly improve response times and increase staff confidence levels. In situ mock codes are a quick and efficient way to provide hands-on practice and allow staff to work as a team.

Assessment of the Quality of Pediatric Cardiopulmonary Resuscitation Using the in Situ Mock Code Tool

“…Positive outcomes for patients following medical emergencies depend on the ability of the first responders -generally nursing staff -to rapidly perform the necessary care in the first few minutes. 5 Regarding this, our data showed some problems. When called for a potentially seriously ill child, most professionals did not assess the patient's responsiveness (73.3%) and pulse (53.3%), delaying cardiac arrest recognition and the start of CPR.…”

“…Another reason for the poor performance in CPR may be the lack of professional confidence, since pediatric cardiac arrest is a rare event; but when it occurs it requires fast, complex and skilled care. 5 We also evaluated team dynamics, considering the topics recommended by PALS. In this regard, we observed good performance and the presence of mutual respect and knowledge sharing.…”

“…[19][20][21][22] By creating a safe and realistic environment, clinical simulation has proven to increase knowledge, practical skills, confidence and emotional control in crisis situations, elements required for good cardiac arrest care. 5,19,22,23 Another benefit of simulations is their ability to train multidisciplinary teams, help identify human errors, and modify team behavior, which leads to the reduction of errors and improved clinical outcomes. 19,24 Thus, we stress the importance of continued training with clinical simulations, followed by debriefing sessions with teams, ensuring health professionals continued education.…”

“…All of the patient resources and facilities are used at a random time unknown by the staff. 5 The surprise element of the in situ mock code allows for the most realistic level of simulation to be attained, bringing in difficulties and emotions that are similar to those encountered when this situation actually occurs.…”

Effectiveness of Education in Improving the Performance of Medical Emergency Team Nurses

“…Previous literature has demonstrated various effective simulation methods used in context of other health care education when confronting and responding to emergency situations. These methods have included simulated clinical scenarios (Jacobson et al, 2010), role-playing (Ertmer et al, 2010), mock code simulations (Delac, Blazier, Daniel, & N-Wilfong, 2013;Hill, Dickter, & Van Daalen, 2010;Herbers & Heaser, 2016), e-learning (Ozekcin, Tuite, Willner, & Hravnak, 2015), humanistic simulation (Dwyer, Reid, McAllister, Guerin, & Friel, 2015) and web-based programs (Liaw et al, 2016;Cooper et al, 2016) as an alternative to simulation methods. Recent meta-analysis of published, controlled studies (1995 -2013) suggests that simulation-based nursing educational interventions have strong educational effects, especially in the psychomotor learning area.…”