1. 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 Purpose Results References Methods 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. 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 Background 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. Nurses, fellows, residents, nurse practitioners, respiratory therapy and pharmacy were invited to participate. 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. PCTU Arrest Evaluations Aug/Sept 2010Oct/Nov 2010 Scale Used1=Poor2= Fair3=Good4=Excellent RN/MD’s evaluate charge nurse in relation to: Facilitated clear, concise communication with team members 3.8 N = 6 3.3 N=9 Anticipated problems and orchestrated timely and accurate responses 3.8 N = 6 3.3 N=9 Demonstrates team leadership during crisis management 3.8 N=6 3.6 N=9 Demonstrate comfort in voicing concern during team interaction and crisis management 3.8 N=6 3.4 N=9 MD’s/RN’s please evaluate RN’s on the following: Organization 3.8 N=7 3.7 N=10 Communication 3.5 N = 7 3.3 N=10 RN’s please evaluate MD’s: Organization 4 N=7 3.8 N=9 Clear concise communication with team members 4 N=7 3.6 N=8 Anticipated problems and orchestrated timely and accurate response 3.7 N=7 3.8 N=8 Were Roles executed effectively and efficiently? 3.8 N=7 3.6 N=8 Do you feel Mock codes have increased your confidence in performing code roles? 3.8 N=7 3.5 N=8 5 East Arrest Evaluations May thru October 2010 November 2010 thru April 2011 Scale Used 1= Poor2= Fair3=Good4=Excellent MD in charge clearly identified self as leader: 3.4 N=16 3.6 N=6 MD in charge used clear concise communication with the team: 3.4 N=18 3.6 N=7 MD was able to anticipate, assist and carry out appropriate interventions according to the patients response: 3.5 N=16 3.8 N=6 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: 3.5 N=16 3.8 N=7 The bedside nurse was able to anticipate, assist and carry out appropriate interventions according to the patient’s response: 3.6 N=14 3.5 N=7 The cart nurse was able to locate supplies and equipment needed: 3.2 N=13 3.6 N=6 Recorder communicated and confirmed medications, interventions and rhythm analysis with team 3.2 N=12 3.2 N=5 Overall team performance 3.2 N=16 2.8 N=8 Overall organization of arrest 2.9 N=16 2.8 N=8 Belief that participation in Mock Codes increased your confidence, communication and competence in this code situation. 3.7 N=12 3.4 N =6 Summary from Mock Code Survey May 2010 to May 2011 Arx, D. & Pretzlaff, R. 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Journal of Trauma, 64, 761-767. 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 Post Arrest Evaluations 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