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PICU Mock Code Committee

Jennifer Hammontree, RN, BSN, CCRN

Co-Chair, PICU Mock Code Committee

Mock Code Committee

Committee History

  • Created by Catherine Kinderknecht in 2017
  • 25% of RNs had <1 year of PICU experience
  • Significant increase in mortality if >20% RNs have <2 years of experience
  • 15 member committee comprised of RNs, RTs, PCTs, Educators, RN Manager, Simulation Lab Specialist and one NP
  • Goal: Quarterly high-fidelity in-situ mock codes

2020 MCC

Evolution of the MCC

  • Over 50 members!
  • Leadership comprised of:
  • 2 Co-chairs: Jennifer Hammontree, RN and Kayleigh Lamphere, RN
  • Education Facilitator: Melissa Lubahn, RN
  • Nurse Manager: Jessica Turk, RN
  • Education Binder: Erin Gratton-Fisher, RN
  • Secretary: Meredith Thrasher, RN
  • Goal: Bi-annual high-fidelity in-situ mock codes and quarterly supplemental roving bedside education events

What do we do?

Committee Events

Mock Codes

Mock Codes

Multi-disciplinary response to simulated code event

PALS scenarios similar to certification checkoff:

  • Upper Airway Obstruction to Bradycardia
  • Septic Shock to V-fib
  • Obstructive Shock to PEA
  • Disordered Breathing to Bradycardia
  • Unresponsive Patient to Pulseless V-tach

Equipment:

  • High-fidelity "Cody" with monitor and defibrillator
  • Low-fidelity "Quinn" with feedback device
  • Low-fidelity baby with feedback device
  • CPR Meter - feedback device >8 years old
  • Rhythm generator to use defibrillator
  • Crash cart with simulation supplies

Participants:

All staff are invited to participate!

Usually 2-3 bedside RNs, 1 RT, 1 provider

*Pharmacist and Chaplain, as available

Roving Education

Roving Education

Participants:

Typically RNs however

Providers and PCTs have participated too!

1:1 to 1:3 bedside education focusing on a code skill

Past Events:

  • Crash Cart Blitz
  • Shock Blitz
  • Code Sheet Documentation Blitz
  • Currently doing second round of this!

Equipment:

  • Crash cart - a real one!
  • Rhythm generator - can deliver shock
  • Simulation medication and supplies
  • Code sheet

Debrief Education

Debrief Education

Did you know?

Simulation staff have created a customized debrief class for our committee members! We have trained 21 staff members in the last year!

  • All events have a real time debrief led by the event facilitator
  • Email debrief will typically include a breakdown of the event, unit trends and answer any questions
  • Bathroom banners provide reinforcement of key take-aways

2019 Survey Results

Survey Results

5 Nurse Practitioners

2 Physicians

67 Registered Nurses

Teamwork

What is your current perspective of teamwork during resuscitations?

Changes

What would you like to change about resuscitations in the PICU?

Providers:

Provider

  • More clear role definitions and communication
  • Doctor communication
  • One leader for the team

RNs:

RN

  • Practice communication, calm presence, closed loop (physician largely sets the tone)
  • Providers to be on the same page and follow PALS algorithm
  • Consistency of practice mentioned several times
  • Debrief from an observer/charge on how the resuscitation went for key role members
  • Clearly defined roles mentioned several times
  • Can Britt Nelson (=ZEN) run all of them?
  • Having a calm leader was mentioned several times

Improvement

Improvement

How could the Mock Code Program improve?

  • More mock codes; more variety in scenarios
  • Repetition
  • KEEP GOING!
  • Have resuscitations for RT/RNs alone?
  • Start working up on the complexity of the events

Future Plans

Future Plans

Multi-Disciplinary Mock Codes

Multi-Disciplinary Mock Codes

Jan 2021

May-Aug 2021

Sept 2021

March 2021

Roving Education: Bagging/CPR

Roving Education: Medications

Nov 2021

Roving Education:

TBD

Future Plans

  • Debriefing Code Sheets after codes (committee led)
  • --> Debriefing after codes (provider led)
  • Mock Code education at staff meetings (including provider meetings :)
  • Practice choreography of the first 3 minutes of a code
  • CPR Coaching as a new role in code management
  • Assist with Code Narrator role-out (currently on hold)

We need YOU!

How YOU Can Help!

Participate!

Participate!

2019 - 29 mock code event days and 12 shock blitz event days

  • 8 of 18 providers participated in one mock code event day (44%)
  • That means 21 mock code event days were "led" by an RN facilitator
  • No one participated in more than one event day
  • 3 of 18 providers participated in the shock blitz

According to attendance records since late 2018, 5 providers have never participated in a mock code!

Join!

Join!

The Mock Code Committee NEEDS you!

  • Currently, Catherine is the only provider - we need more voices/ideas/advocates!
  • Meetings are every two months with two time options (virtual, for now)
  • Discuss past events
  • Plan for future events
  • Practice mock code scenarios!

Debrief!

Debrief!

Debriefing staff is the most beneficial way to provide education - and they WANT you to give feedback!

When to debrief?

  • After a code
  • After any bedside interventions
  • After bedside report
  • Anytime you see an area for improvement!

Code debriefing

  • Can be formal (huddle with all staff) or informal (one-on-one)
  • Knowledge share:
  • What happened with the patient?
  • What went well? What could have gone better?
  • Why did you choose certain interventions? (especially important if you deviated from PALS)

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