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
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
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
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
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!
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!
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!
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)