Use of Simulation to Enhance Code Blue Computerized Documentation Kathleen M. Warken RN, MS, CMSRN Callie Gollihue RN, MSN, CCRN Megan Vasseur RN, DNP, CMSRN

Objectives Review barriers to computerized code blue documentation Discuss the use of simulation to improve documentation of code blue events using the electronic medical record (EMR) Describe pre/post simulation data collection results after the implementation of a Code Blue documentation simulation

Who Are We? Mission Statement: As a Catholic healthcare ministry, we provide comprehensive and compassionate care that improves the health of the people we serve.

4 Magnet® , 2010, 2015

Laying the Foundation To provide the best care to our community, it takes a team of skilled, competent providers Simulation training enhances the safety and effectiveness of the healthcare team Simulation training began in 2009

Growth of Participants

Electronic Medical Record (EMR) Utilization of an EMR started in our facility in 2010 Flowsheet documentation is the primary form of documentation in the EMR used by inpatient staff nurses Code Blue documentation uses a “narrator style” which is geared to the faster pace of documentation required during a code event

Importance of EMR Documentation During Code Blue Event According to the American Heart Association (2013) “Improving outcomes for in-hospital cardiac arrest (IHCA) requires a change in the culture through standardized reporting, knowledge, training, and better systems of care.” Legible documentation during a high stress event Fewer errors related to misinterpreted documentation Ability to quickly document life-saving treatments Allow medications to be ordered and administered in a couple clicks Utilization of a “quick bar” for code related interventions

Nursing Barriers to the EMR Code blue events are low volume, high risk skills Urgency of situation Varying degrees of computer literacy Perception that it takes longer to document in the EMR versus paper documentation Logistics - where do you place a computer in an already crowded room?

Training Initial EMR training classes prior to go-live Super Users available during go-live in 2010 In 2011, we temporarily went back to paper documentation for code blue events House wide education given before reinstating the code narrator in the EMR in 2013 Unit code blue training allowed a nurse to document during the mock code blue EMR training environment is always available for staff to access

How Can Every Nurse Get Exposure to Documentation of a Code Blue Event? Skills for code blue events are practiced but how are we reinforcing the documentation process in EMR, a task that can be foreign to many nurses Video tape a simulated mock code blue using an inter-professional team of current staff members. WOW, I should have thought of that sooner!! Nursing units come to the Simulation Center annually for their individual unit skills day 2015 was the first year of using the video-taped mock code blue for unit skills days The 2016 needs assessments requested for it be repeated again

Mock Code Blue Video

% Improvement in Documentation First Quarter

% Improvement in Documentation Second Quarter

% Improvement in Documentation Third Quarter

% Improvement in Documentation Fourth Quarter

Evaluation Code Narrator Documentation Station enhanced my ability to document during a code blue event: 227 Acute Care nurses rated 4.3/5 222 TCU nurses rated 4.4/5 109 Critical Care nurses rated 4.4/5

Comments From Participants “Video of code very helpful to me. Continue with code simulation and code documentation, watching code on TV.” “I am more familiar with code narrator.” “Code narrator station was very helpful!!” “Code narrator, have not used it. Feel more comfortable using it now.” “I greatly appreciated the code navigator and mock code.”

Contact Information Kathy Warken, MS, RN, CMSRN (859) Callie Gollihue, MSN, RN, CCRN (859)

References American Heart Association. (2013). Top ten things to know improving survival after an in-hospital cardiac arrest in the US. Retrieved from Duncan, K. (2015). If it’s not documented, it wasn’t done. Journal of Radiology Nursing, 34 (1), Kunz, M. (2010). Helping nurses overcome possible barriers. Nursing for Women’s Health.14 (4), Stokowski, L. (2013). Electronic nursing documentation: Charting new territory. Medscape Nurses. Retrieved from