Improving Code Blue Response Through the Use of Simulation

Improving Code Blue Response
Through the Use of Simulation
Kelley F. Huseman, MSN, RN-BC, CCRN
Ephrata Community Hospital
Ephrata, PA

OBJECTIVES
• list the AHA benchmarks of best practice
for resuscitation
• list problems with current resuscitation
training
• name advantages of simulation in
resuscitation training
• discuss the research project and results
of project relating to improving response
time for a cardiac arrest

Overview of the Research Project
Project Choice:
Requested by Executive Management to
improve code blue response
Various approaches tried and failed
Given gift of high fidelity patient simulator
(iStan)
Initiated code blue drills in hospital
Needed to assess effectiveness

Overview
Research Question:
Will participation in simulated code blue
drills improve code blue response times
and will the improvements be sustained

Literature Review
Stressors of Resuscitation
Best Practices
Importance of Timely Response
Issues with Current Training
Effects of Simulation on Practice
Barriers to the Use of Simulation

Stressors of Resuscitation
• High Risk-Low Volume
• Team must function effectively and
quickly in order to have a good outcome
• Nurses report feeling incompetent in
performing in a code blue situation
• Many are uncertain as to their role in a
code blue

AHA Best Practices
• Chest compressions start within one
minute
• Defibrillation performed within three
minutes
• Epinephrine administered within five
minutes

Importance of Timely Response
• Average survival rate 10%
• Delays in treatment increase the
likelihood of death 1.1 times per minute of
delay
• For every minute defibrillation delayed,
survival rates decrease by 10%
• The shorter the time between arrest and
intervention, the better the chance for
survival

Issues with Current Training
• Majority of healthcare workers cannot
perform appropriately in an arrest
situation
• Skills erode within the first three months
after training
• Structured classes are unrealistic
• Scheduled classes cannot replicate the
anxiety of a true arrest situation

Effects of Simulation on Practice
• IOM has recommended simulation
training to reduce errors
• Skills and clinical decision making can be
practiced in a nonthreatening
environment
• Less stressful than real life
• More realistic than traditional training
• Remediation and debriefing can be done
immediately
• Enjoyed by participants

Barriers to the Use of Simulation
• Expense
• Expertise
• Facilitator availability
• Staff and physician buy-in

Overview of the Project
Quasi-experimental, single sample
Cannot predict who, where or when
code will occur
Cannot manipulate variables
Cannot predict staff responders

Overview of the Project
Setting
Small Community Hospital
Participants
All patients/staff involved in code blue
Procedure
Conducted Mock Code Drills
Measured code response times pre and posttraining

Results & Discussion
Improvement in mean times for:
Chest compressions
Epinephrine dose
Defibrillation
Pretraining
Post -
training
Q 2, 2010
Chest
Compressions
0.867 min 0.214 min 0.375 min
Epinephrine 4 min 0.929 min 0.05 min
Defibrillation 3.286 min 1 min 1 min

Results & Discussion
Mean Response Times
6
5
Minutes
4
3
2
Benchmark
Pre-training
Post-training
Maintenance
1
0
Compressions Epinephrine Defibrillation

Results & Discussion
t- tests
Chest Compressions
Pre to post training t = 2.8717 (p = 0.0079)*
Post-training to Q 2 t = 0.5517 (p = 0.5983)#
Epinephrine
Pre to post training t = 4.6602 (p = 0.0001)*
Post-training to Q 2 t = 0.5517 (p = 0.5517)#
Defibrillation
Pre to post training t = 1.7778 (p = 0.1008)
Post-training to Q 2 t = 0.0000 (p = 1.000)
*Statistically significant
#Sustained improvement

Conclusions
The use of simulation appears to have a
positive impact on code blue response
times.
These results were sustained through the
second quarter of 2012.

Implications & Suggested Changes
Retention of resuscitation skills declines
rapidly after BLS and ACLS training.
These training classes occur formally
every 2 years.
In order to maintain skills, staff needs to
participate in practice sessions.
Unannounced code blue drills appear to
assist with skill retention
Code blue drills should continue to be
conducted on at least a monthly basis

Limitations
Small number of actual patient codes
It is possible that response did not
change, but documentation improved
Confidence levels were not directly
measured, further study should be
conducted relative to confidence levels

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