1. MARIELLA A. WHILE, RN, BSN, MED MARY KAY LOYD, RN A New Approach to Emergency Code Blue Training

2. Conflict of Interest We have no conflicts of interest to diclose

3. SEEKING MASTERY A New Approach to Emergency Code Blue Training Multiple approaches and buy in Results

4. Where Are the Pitfalls? Education  Psychomotor Skill Gap  Cognitive Knowledge Gap Defibrillator  Psychomotor Skill Gap  Cognitive Knowledge Gap System

5. Pitfalls in the Education Process Pitfalls leading to program development Collaboration with Code Blue Committee Need to reinforcement the primary survey with the staff BLS Training

6. Pitfalls With the Defibrillator What contributes to delays?  Staff policies  AED function of defibrillator unknown  Placing EKG leads  Connecting defibrillator  How often do we reanalyze and shock?

7. Pitfalls With the In-House System What contributes to delays? Supplies Pagers  Paging delays  Delay in team arrival

8. What was Happening in House? Rapid Response activation=decreased Code Blue rates  Decreased experience with activating and responding to a Code Blue  Staff participation in codes was estimated 1 every 5 years New BLS /ACLS guidelines Standardize a system for ACLS and BLS programs  Inconsistent training

9. Desired Outcomes Reduce time from discovery to defibrillation to 3 minutes Improve performance as a team at the bedside Improve system barriers

10. Essential elements of success Champions  Code Blue Committee Chair  Clinical Nurse Liaison/Clinical Nurse Specialist  Clinical Simulation Center Staff

11. Where do we train? In Situ  Empty patient room  Hallway  Clinic room  Garage In the Clinical Simulation Center  6 individual rooms

12. Methodologies PROGRAMS DEBRIEF MNEMONICS REPETITION

13. Programs in Place to Improve Pitfalls Code Blue In Situ Mini Code Blue In Situ Code Blue Challenge Code Blue Readiness Resident Code Blue Refresher

14. “CCC,ABC,123” Mnemonic Break the BLS survey down in a way the participants can remember  Desire a visual aid  Frantically write it down  Musical

15. Mnemonics Work BLS Primary Survey: CCC, ABC,123  Check  Call  Care Airway Breathing Circulation 1-Turn defibrillator on  Pads placed/ connected 2-Analyze 3-Shock if advised

16. Code Blue Readiness Goal:  Improve primary survey  Promotes proper use of equipment  Improve code blue discovery to defibrillation times  Build confidence in nurses and techs  Improve performance as a team at the bedside Addresses both educational and defibrillator pitfalls

17. How do we do it? Started as:  Prep for residents rotating into code blue team  Scheduled champion faculty biweekly  1 hr. algorithm review – minimal on BLS survey  Champion faculty evaluation vtach>vfib>PEA  Code Blue Practice for team training Code Blue Readiness

18. How do we do it? Evolved to:  Focus on the BLS process for nurses and techs throughout the hospital  To the sim center for training Code Blue Readiness

19. How Do We Do It? Schedule:  Preregister for a session through SITEL's Learning Management System  Not limited  Bimonthly for a hour Tools:  “CCC, ABC,123”  Human patient simulator  Drug box, BVM, defibrillator and pads Code Blue Readiness

20. Code Blue Readiness Process The Process  BLS primary survey review using the mnemonic “CCC, ABC,123” on a human patient simulator Put it all together!  Hands on practice moving through the BLS Primary Survey for 10 minutes Coaching environment Debrief Code Blue Readiness

21. Teaching Using the “CCC,CAB,123” Mnemonic Check for responsiveness, breathing, movement Call for help, AED Care Airway  Head tilt/chin lift Breathing  Use of BVM-technique Circulation  Assess-0 pulse + 0 breathing=CPR Why VS? Call a code!  CPR- technique- Harder& faster 100x/minute, 2 inches 1  Turn it on 2  Analyze mode 3  Shock if indicated- Resume CPR- 2 minute cycle Code Blue Readiness

22. Mini Code Blue In Situ Code Blue Challenge Goal:  Improve all around performance as a team at the bedside  Improve code blue discovery to defibrillation times  Improve primary survey process  Build confidence in nurses and techs  Promotes proper use of equipment Addresses both educational and defibrillator pitfalls

23. How we do it? Started as:  Difficult for staff to come off unit for an hour to attend the Code Blue Readiness Class  Defibrillator training on the individual units didn’t happen  In Situ-we went to them Schedule:  Limited to once per week + blitzes  Prearranged date and time with unit director  No bed- conduct session in gym, hallway Tools:  “CCC, ABC,123”  Human patient simulator  Drug box, bvm, defib pads and unit defibrillator Mini Code Blue In Situ

24. The Process  Roll onto the unit with the human patient simulator  AA at the front desk is informed not to call the code overhead  Staff member gets a sim brief and is asked to come see a patient brought up from the ER who “doesn’t look good”  Allow them to move through the BLS Primary Survey timed by team  Nurses and techs arrive from the unit in response to the call for help.  Ready? Go/No Go by educator  Educator steps in as a team leader to move further through the code.  Debrief Mini Code Blue In Situ

25. Debrief using “CCC,ABC,123” Mnemonic Check for responsiveness, breathing, movement Call for help, AED Care Airway  Head tilt/chin lift Breathing  Use of BVM-technique Circulation  Assess-0 pulse + 0 breathing=CPR Why VS? Call a code!  CPR- technique- Harder& faster 100x/minute, 2 inches 1  Turn it on 2  Analyze mode 3  Shock if indicated- Resume CPR- 2 minute cycle Mini Code Blue In Situ

26. Keeping track Data sheet for each of the 2 simulation staff trained in this area Sign in Data entry Mini Code Blue In Situ

27. Resident Code Blue Refresher Goals:  Improve performance as a team at the bedside  Improve code blue discovery to defibrillation times  Addresses both educational and defibrillator pitfalls

28. How Do We Do It? Started as:  Code Blue Readiness Evolved to:  Current Course-preregister  Prep for 10-15 residents carrying the code pager  Focus not as broad Resident Code Blue Refresher

29. How We Do It (continued) Schedule:  First Friday of the Month for a hour in the Clinical Simulation Center Tools:  “CCC, ABC,123” poster  Megacode poster  Human patient simulator  Drug box, BVM, defibrillator and pads Resident Code Blue Refresher

30. Where Do I Start When I Am the Team Leader? Communication- The door swings both ways Is the CCC, ABC,123 in place? High Quality CPR? Ventilations effective with the BVM? Pads on chest, connected, and rhythm analyzed? What mode are you in on the defibrillator? Roll into algorithm Resident Code Blue Refresher

31. The Process BLS primary survey  “CCC,ABC,123”  Tying the programs together ACLS  Algorithms Put it all together!  Group performs CPR, ventilates with BVM, hands on practice with defibrillator, opens and gives drugs. Coaching environment- fun and energetic Debrief  Team Lead is a tough job! Resident Code Blue Refresher

32. Code Blue In Situ Goal:  Improve all around performance as a team at the bedside  Build confidence and collaboration amongst all members of the code team  Improve code blue discovery to defibrillation times  Improve primary survey process  Promote proper use of defibrillator Addresses educational, defibrillator, and system pitfalls

33. How Do We Do It? Started as:  Monthly In Situ Evolved to:  Weekly In Situ Schedule:  Prearranged Dates  Random bed assignment Tools:  Human patient simulator  Unit crash cart, defibrillator, pads, BVM  “CCC, ABC,123” poster Code Blue In Situ

34. The Process Surprise! Staff member gets a simulation brief BLS Primary Survey timed by team Code is called overhead Debrief Code Blue In Situ

35. Collecting the Data Data sheet for Code Blue Committee chair Data sheet for each of the 2 simulation staff well trained in this area Sign in Data entry Code Blue In Situ

36. Debrief of the Team Self Evaluation of the team Breakdown of the InSitu by Sim team  System challanges Lessons Learned  Where did we do well?  Where can we improve?  Did we reach the AHA goal of 3 minutes from time of discovery to the first defibrillation? Education Code Blue In Situ

37. Closing the Gap

38. More Than One Approach Recertification 2 years  Not enough Multiple programs needed to practice skills in order to retain knowledge  Collaborative approach to training Breaking the Silos Frequency of In Situ  Increasing requests for practice and training in activating and responding to a code blue with a real life response. Feel of the session Coaching with education Just in time training After In Situ training Code Blue In Situ

39. Just In Time Team Training Improved In Situ Time to Defibrillation Staff Training Resident Training In Situ

40. On The Horizon Continue our programs to further close the gap towards AHA goal of 3 minutes Continue our programs with utilization of new BLS & ACLS guidelines System wide initiative to promote code blue response Formal research

41. QUESTIONS? Thank You!

42. Feel Free to Contact Us Mary Loyd, RN, Clinical Simulation Educator  Office Phone: 202-877-3217  Email:mary.loyd@email.sitel.org Email:mary.loyd@email.sitel.org Mariella While, RN, BSN, Med, Senior Clinical Simulation Educator  Office:202-364-5180 x 143  Email:mariella.while@email.sitel.org