95. Effect of a pediatric mock code on resuscitation skills and team performance: an in situ simulation experience over three years.

Abstract

Introduction: Early initiation of high-quality cardiopulmonary resuscitation (CPR) significantly improves the outcome of cardiopulmonary arrest in the hospital. Mock code simulation significantly reduces the time between the cardiac arrest event and the initiation of CPR. This type of simulation training facilitates the acquisition of critical CPR skills and improves team performance, which significantly improves cardiopulmonary arrest survival rates and leads to better clinical outcomes. In situ mock codes allow interprofessional teams to learn how to work together and how to improve the skills that are necessary to provide optimal CPR in a realistic environment in which patient safety is not threatened. Methods and procedures: Simulation program design and Participants: The mock code simulation program at King Abdullah Specialized Children’s Hospital - King Abdulaziz Medical City in Riyadh, Saudi Arabia, uses an in situ mock code simulation, and it is held 2-3 times per month on random wards in any unoccupied patient room at an unexpected time. The pediatric residents in our hospital serve as leaders of the pediatric cardiac arrest team. The code team is composed of pediatric ward nurses, in addition to pediatric intensive care nurses, respiratory therapists, pharmacists. The time it took to initiate CPR, the first epinephrine dose, and defibrillation were evaluated for team improvement using an evaluation form. The evaluation form included also team dynamics evaluation as nontechnical evaluation, and it included an assessment of effective leadership and closed-loop communication. Study design: This was a retrospective descriptive study conducted at King Abdullah Specialized Children’s Hospital. All records of the mock code simulation sessions conducted from July 2016 to June 2019 in the pediatric wards were included. Data were usually recoded and archived for each session in simulation program files, and they included a crisis resource management (CRM) score for the team leader. Other data related to team members’ performance was also documented, including the CPR initiation time and the overall team performance assessment. Outcomes: The purpose of this research project was to explore the impact of simulation-based training on resuscitation skills. The primary outcome was to assess the impact of the mock code simulation on the team’s performance by assessing CPR initiation time. Results: A total of 82 sessions met the inclusion criteria. CPR initiation time: With each attempt of a mock simulation for each pediatric ward of the nine pediatric wards where mock code was conducted, there was a significant decrease in the CPR initiation time by 6 seconds (p=0.0002) (Table 1).Non-Technical Team performance assessment (total global rating score): The results showed significant improvements in team performance as represented by the total global rating score for each pediatric ward team over a series of mock code simulation sessions, and the score increased by 3.4 times (=0.0001) Discussion: The results of this study showed improvements in the time it took to initiate CPR over a series of mock code simulation sessions that were conducted for each pediatric ward’s team. Initiation of CPR was related mainly to first responders and was the responsibility of the ward nursing staff in our study, and by repeating the mock code sessions, the ward nursing staff showed significant improvements in initiating CPR by accomplishing a faster CPR initiation time. This improvement also reflects that the recognition of a patient in cardiac arrest is better as well as the sequence to respond to a collapsed child. The team performance was assessed using the global rating score by conducting a series of mock code simulations in pediatric wards with intervals of three months. The results showed improvements in team performance overall and in team dynamics and communication specifically. This finding was also represented by improvements in the time to administer the first epinephrine dose, which reflects the harmony of efficient teamwork. Conclusion: In situ mock code simulation is a helpful way to enhance team dynamics and improve the quality of cardiac resuscitation. It can also help with skill retention for team leaders and team performance. Critical skills and CPR initiation time were greatly improved by continuous mock code simulation training for the code team. These results suggest advantages for considering this type of educational strategy for pediatric residents, code teams, and nursing staff, and they also support the continued use of ongoing mock code simulation training to further improve team performance, maintain team leader confidence, and assure quality patient care.