Board #201 - Program Innovation Mock Code for Real Changes

Abstract

Objectives Traditional mock code programs focus on resuscitation efficiency and patient outcomes. Concepts such as communication, teamwork, clear roles/responibilities and performance measures remain the main obectives. Our Medical Emergency Response Improvement Training (MERIT) program has been designed not only to improve traditional code blue performance metrics, but to drive practice changes that enhance patient safety, systems integration and address operational deficiencies. Using our hospital’s focused efforts on continuous improvement, our monthly mock codes and/or rapid responses are either preplanned scenarios or derived from a specific request of an area within the hospital to practice a “low-volume/high-risk” scenario they have experienced. Description This example of a solicited event was a hybrid simulation of an adult collapse in the employee gym. Objectives for this event included: recognition of the victim, system activation, team response, staff access, AED use, code cart/stretcher arrival, documentation and communication. With MERIT team members located inside the gym and in the security office, we captured objective data from multiple perspectives. The event was initiated with a standardized patient collapsing while on a treadmill. The Code Blue was announced after an emergency call was placed. As teams arrived, the standardized patient was replaced with a manikin and resuscitative efforts began. The objectives and overall performance were assessed and documented. Following the event, a debriefing was conducted. Opportunities were communicated to divisional leaders for review and follow-up. The event was conducted again a few months later. This mock code was conducted in July, 2013 and involved 15 employees with direct code responsibilities. This event revealed 12 deficiencies in processes, systems, equipment availability, and supplies. Each finding was analyzed, summarized and communicated to the appropriate leaders, via detailed summary. An analysis of these findings was conducted at the operational level. Conclusion Improvements were developed by the teams directly involved, including code team responders. Changes were communicated to all appropriate staff as well as the MERIT team. The event was replayed a few months later to evaluate the effectiveness of the changes. We found seven process changes were enabled through continuous improvement, one was no longer relevant and four are in-process improvements that require more planning and education. Our MERIT program is part of our commitment to clinical excellence and continuous improvement through interprofessional collaboration, simulation and education. The program has exposed and addressed operational deficiencies; it has directly and indirectly contributed to the continuous process improvement initiatives recognized by our leaders as a major component of our success. This program has also enabled our hospital to continuously improve the care we provide to not only our patients and their families; but also our employee engagement by empowering them to be involved with their leaders in the practice changing process. More work needs to be done in follow-up and education post mock code. An in-process plan is the development of a simulation video to serve as a template for addressing operational deficiencies relevant to our setting.