Mock Code Simulation Research Articles

Abstract WP262: Enhancing Stroke Knowledge Among Youth: Insights from Stroke Busters

Introduction: Educating youth about stroke can improve stroke knowledge in communities. Stroke Buster s, a 5-day program for high school students, consists of interactive stroke lectures, a mock stroke code simulation, and a hands-on thrombectomy demonstration. In 2022, we found that the program was efficacious in improving stroke knowledge using pre/post-tests. In 2023 we designed a consolidated 1-day program, and also repeated the annual 5-day summer program. We assessed pre/post-test knowledge for each workshop, long-term retention, and if teaching the program improved knowledge for prior participants. The optimal duration and format of stroke education for youth is not known. Methods: Students from three cohorts of the Yale University Pathways to Science program participated in Stroke Busters: 13 students from Summer 2022 (5-day, 90 min/day), 14 from Spring 2023 (1-day, 90 min), and 15 from Summer 2023 (5-day, 90 min/day). Student demographics of the overall Pathways to Science program were 31% White, 29% Black, 28% Hispanic, 12% Asian and <1% other. 8-question pre/post tests were administered at the beginning and conclusion of each session, as well as 8 months following the summer 2022 program. Results: Scores were similar for both summer (5-day) programs, increasing from 36.3% (pre-test) to 66.3% (post-test) in 2022 and from 41.7% to 62.5% in 2023. For the 1-day program, the scores increased from 35.7% to 62.5%. Post-test scores were similar for both the 5-day program and the 1-day consolidated program. Five students from the 2022 summer program replied to the 8-month follow up survey, resulting in an average test score of 65%, which was similar to their immediate post-test score of 66.3%. Two students from Summer 2022 (5-day) returned to teach the Spring 2023 (1-day) program, and their average test score after teaching was 87.5%. Conclusion: Stroke Busters is efficacious in promoting long-term retention of stroke knowledge among high school students; students who taught the course retain knowledge even better. The equivalence of post-test scores between the 5-day and 1-day programs offers valuable insights for resource optimization without compromising education quality.

Optimizing Education During Pediatric Resident Mock Code Sessions.

Most pediatric residents have limited opportunities to manage cardiac arrest. We used simulation to fill that educational void. Given work hours and other obligations, resident education sessions must be high-yield. We examined the effectiveness of adding varying amounts of formal education to a mock code session on resident knowledge and confidence in managing pediatric cardiac arrest compared with participation alone. Convenient groups of 3 to 8 pediatric residents completed a simulation session with the identical scenario: a 3-month-old infant with pulseless ventricular tachycardia and then pulseless electrical activity. All residents completed pretests and posttests, which consisted of open-ended knowledge questions from the American Heart Association Pediatric Advanced Life Support guidelines and confidence Likert scale assessments. Resident groups were assigned to 1 of 3 educational models: experiential-only: participation in the mock, traditional: mock code participation with standardized education after the mock code, or reinforced: standardized education before and after mock code participation. Ninety-five residents participated. Collectively, residents demonstrated a median 2-point (interquartile range, 1-4) increase in knowledge (test maximum score, 10) after they attended a mock code simulation session ( P < 0.0001); however, there were no statistically significant differences noted between educational modalities. All residents also demonstrated a 4-point median increase in confidence (test maximum score, 25) after completing their simulation session (interquartile range, 3-6) ( P < 0.001), but no differences were seen by type or amount of accompanying education. Residents had gains in confidence and knowledge of pediatric cardiac arrest management after participation in the mock code. Formal educational sessions and reinforced formal education sessions accompanying the mock code did not significantly increase knowledge or confidence.

Abstract 62: Stroke Busters High School Stroke Education Initiative

Background: It is estimated that 91% of stroke risk can be attributed to modifiable risk factors; however, on a population level, these risk factors are not well controlled. One recent response to reducing the burden of stroke has been to improve childhood knowledge about stroke. The purpose of our initiative was to educate high school students about stroke and careers in neuroscience. Methods: Thirteen students in Yale University Pathways to Science Summer Scholars participated in a 5-day program called Stroke Busters. Summer Scholars is a free summer science day program for rising 10th- 12th grade students. The demographic breakdown is 32% Asian, 30.1% Black, 20.4% Latinx, 15.5% White, and 1.9% Middle Eastern. Stroke Busters is a program within Pathways that includes an interactive stroke lecture, mock stroke code simulation, interactive mechanical thrombectomy demonstration, and a workshop where students created their own stroke learning materials. Students completed an 8 question pre and post-test that assessed stroke knowledge. Results: Between 7/11-7/15/22 thirteen students participated in Stroke Busters . The average test scores increased from 38% to 73%. Prior to the program, eight students (62%) listed that a stroke occurred in the brain and four students (31%) correctly identified the acronym “FAST”; 100% of students got these items correct in the post-test. The score for identifying 4/4 stroke symptoms improved from 56% to 92%. Twelve students provided feedback; the overall satisfaction rating for the program was 4.44/5. Students commented on the stroke simulation as the most enjoyable part of the program. Conclusion: In this high school stroke educational program students improved their knowledge about stroke significantly. This is the first stroke education program to our knowledge that focuses on high school students using a multi-day curriculum led by a diverse group of healthcare professionals.

Introducing Nursing Students to Pastoral Care Providers Via Simulation.

During a mock code simulation scenario in a medical-surgical undergraduate nursing course, two priests as pastoral care providers were included as interprofessional team members. Perceptions of the inclusion of pastoral care in an end-of-life simulation were assessed as part of a mixed-method study that included a qualitative analysis of debriefing sessions. Students reported an increase in awareness of the role of pastoral care in healthcare and learned to consider the spiritual aspects of end-of-life care. Participation of priests in an end-of-life simulation enhanced students' learning of spirituality as an aspect of nursing care.

Effects of Mock Code Blue Simulations on New Graduate Nurses Confidence Levels

Objective: Determine if new-graduate nurses' participation in mock code simulations improves their confidence during code blue situations. Design: Quasi-experimental, Comparative Setting: Hays Medical CenterParticipation: New Graduate Nurses from Fort Hays State UniversityResults/Conclusion: Pending results and data collection.

Development and use of an infant resuscitation performance tool (Infa-RePT) to improve team performance.

Measurement of neonatal team resuscitation performance is critical to identify opportunities for improvement and to target education. An effective tool to measure team performance during infant resuscitations is lacking. We developed an in-hospital infant resuscitation performance tool (Infa-RePT) using the modified Delphi method. We employed a QI framework and targeted interventions, including the use of role responsibility checklists, mock codes, and an educational video. We tracked Infa-RePT scores, mock code team attendance, and confidence surveys. Our specific aim was to improve Infa-RePT score from a baseline of 7.4 to <5 (lower is better) over a 26-month period. Twenty-five elements reached >80% consensus as essential components to include on the Infa-RePT. Independent observation showed 86% concordance on checklist items. Simulation (n = 26) and unit-based code (n = 10) Infa-RePT scores showed significant improvement after project start from 7.4 to 4.2 (p < 0.01) with special cause variation noted on control chart analysis. No significant difference was observed between simulations and in-unit codes. Staff confidence self-reports improved over the study period. Use of a novel scoring tool can help monitor team progress over time and identify areas for improvement. Focused interventions can improve resuscitation team performance. We developed and used a novel, comprehensive measurement tool for team infant resuscitation performance in both simulation and in-unit settings. Using QI methodology, team performance improved after the enhancement of a mock code simulation program. Review of team performance scores can highlight key areas to target interventions and monitor progress over time.

An In Situ Mock Code Program in the Pediatric Intensive Care Unit: A Multimodal Nurse-Led Quality Improvement Initiative.

Lifesaving resuscitation is required for approximately 1 in 100 patients in the pediatric intensive care unit. Certification renewal alone is insufficient to guarantee adequate knowledge, skills, and confidence among staff members involved in infrequent resuscitation events. Knowledge and skill gaps were identified in pediatric intensive care unit staff members involved in patient resuscitation events. The primary aim of this quality improvement project was to optimize patient resuscitations through improved staff performance and coordination between interdisciplinary roles. A multidisciplinary committee was created to develop, implement, and evaluate a mock code program. Surveys were administered before and after the intervention to assess self-perceived resuscitation performance and program effectiveness. Code sheets were analyzed for documentation quality and adherence to pediatric advanced life support guidelines. The committee used a multimodal approach to education, including high-and low-fidelity in situ mock code simulations and supplemental educational events. From September 2018 through January 2020, the committee conducted 65 events for almost 500 participants. Nurses' levels of self-reported confidence in initiating pediatric advanced life support interventions and identifying cardiac rhythms increased, as did perceived level of competence and knowledge. Most unit staff members considered the mock code program to be "very to extremely effective" in increasing resuscitation competence, confidence, communication, teamwork, and role clarity. Adherence to recommended resuscitation behaviors improved, as did code sheet documentation quality. An in situ mock code program using a multimodal approach to education can be a successful educational adjunct to biennial pediatric advanced life support certification.

Interprofessional mock code simulation promotes collaboration and competency in Parkinson's medication safety during transition in care

An interprofessional mock code simulation was designed to educate students from four healthcare disciplines on the care of a patient with Parkinson's disease (PD) during a care transition. This interprofessional education initiative facilitated students learning about, from, and with each other. The simulation consisted of an unfolding patient with Parkinson's disease (PD) that involved an incomplete medication reconciliation and an omission of time-sensitive PD medication, resulting in a full code. The simulation explored quality improvement strategies for safe and timely medication administration and reconciliation during a care transition for a patient with PD. The simulation was conducted in the Learning Resource Simulation Center with small groups of students from two separate institutions and four separate schools or college programs rotating throughout the semester. The student participants consisted of the following: Baccalaureate Degree Senior Nursing Students; Master's level Senior Nurse Anesthesia Students; Fourth-Year Doctor of Osteopathic Medicine Students; and Fourth-Year Doctor of Psychology Students. The objectives of the interprofessional mock code simulation were as follows: 1) learners shall understand the roles and responsibilities of members of a healthcare team by participating in an interprofessional simulation of a patient with Parkinson's disease during a mock code scenario; 2) learners shall recognize the harm that occurs from incomplete medication reconciliation specific to Parkinson's disease during care transitions such as disorientation, garbled speech, severely limited breathing capacity and even death; and 3) learners from four different healthcare disciplines will evaluate their comfort and competence specific to working as part of an interprofessional healthcare team during a mock code simulation. The simulation demonstrated an increase in knowledge among all the interprofessional healthcare team members regarding PD medication safety. This PD unfolding case study simulation training also helped students and future professionals feel comfortable and competent while working together during a patient code situation in the acute care setting. This simulation holds great potential for dissemination among all faculty disciplines to improve the quality and safety of the PD population during care transitions. A complete copy of the IPE simulation is available upon request from the primary author.

78. PERFORMANCE UNDER PRESSURE: THE USE OF EPAS TO STANDARDIZE PEDIATRIC MOCK CODE FEEDBACK

Background Pediatric mock code simulation plays a critical role in the development of a trainee's decision making ability for high-stakes, low frequency situations. To ensure trainees receive maximal benefit from these simulations, it is important that they receive optimal, timely feedback. Objective The aim of this study is to characterize the implementation and pilot use of the American Board of Pediatrics’ (ABP) Entrustable Professional Activities (EPAs) for mock code feedback. Methods We designed a simulation-based education intervention study of pediatric trainees at a large pediatric residency program. To ensure consistency and breadth of experience, a standardized mock code curriculum of 13 cases was created. An online assessment tool was created based on the ABP's EPA 10 (resuscitation and initial stabilization) incorporating objective clinical behaviors that the learner must display during the simulation. EPAs and communication were rated based on narrative anchors with seven and five possible levels, respectively. The tool was used to facilitate and record feedback between the instructor and trainee. In addition, other mock code participants evaluated the trainee using the tool in real time. Results 6 months since implementation, 21 residents (45% of PGY-2, PGY-3 classes) have received one-to-one verbal and written feedback using our tool following a mock code. 90 evaluations were completed by faculty and observers. The average EPA rating and communication score of residents was 5.4 (SD 1.27) and 3.66 (SD 0.75), respectively. There were no significant differences observed in the EPA or communication scores between the observers and faculty (P = 0.46 and 0.8, respectively). In the post-simulation survey, 93% (13/14) of trainees indicated the feedback process would improve their future performance. Conclusions An EPA-based, online assessment tool was feasible and easily incorporated into mock code simulations. We found that observers with varying levels of expertise gave similar ratings, suggesting future possibilities of using peers for feedback in mock code settings.

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

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.

The Impact of Mock Code Simulation on the Resuscitation Practice and Patient Outcome for Children With Cardiopulmonary Arrest.

BackgroundCardiopulmonary arrest is an uncommon event in pediatric patients. Additionally, physicians-in-training see far fewer cardiopulmonary arrest events. Therefore, they have limited confidence in their resuscitation skills. Mock code training with active participation and debriefing may be an effective tool to fill this gap in experience. The aims of the study were to assess the impact of a mock code simulation program on patient outcome for children with cardiopulmonary arrest in a tertiary pediatric academic center and provide evidence that code simulations can improve the quality of cardiopulmonary resuscitation (CPR).MethodsThis was a retrospective cohort study conducted in a tertiary academic center. This study had two phases: Phase 1 before the mock code simulation program began (pre-intervention) and Phase 2 after the mock code program began (post-intervention). The data were collected from pediatric patients with cardiopulmonary arrest during the study period who met the inclusion criteria, and variables included the survival rate at hospital discharge, CPR initiation time, time to the first dose of epinephrine, and the adherence rate to American Heart Association (AHA) guidelines.ResultsA total of 13 patients in the pre-intervention period and 19 patients in the post-intervention period were included. The results showed a significant improvement in team performance represented by a decrease in CPR initiation time post-intervention and improvement in AHA adherence; however, the results did not show a significant difference in the survival rate or mortality within 28 days of the cardiopulmonary arrest event between the pre- and post-intervention groups.ConclusionsMock code simulation was a helpful tool to enhance team performance and improve the quality of cardiac resuscitation and cardiac arrest recognition, while its impact on the survival rate was not significant in our study.

Effect of a Pediatric Mock Code Simulation Program on Resuscitation Skills and Team Performance

BackgroundThe timely delivery of high-quality cardiopulmonary resuscitation (CPR) is a key measure of quality life support and patient safety. Code simulation training facilitates the acquisition of resuscitation skills and improves team performance, which significantly improves cardiopulmonary arrest survival rates and improves patient safety. The purpose of this study was to explore the impact of simulation-based training on resuscitation skills and to provide evidence that code simulations can help improve team skills and the quality of team leadership. MethodThis was a retrospective descriptive study. All records of the code simulation sessions conducted from July 2016 to June 2019 in the pediatric wards of a hospital were included. The data reviewed and analyzed included a crisis resource management score for the team leader and data related to team members’ performance, such as the CPR initiation time and the overall team performance assessment. ResultsA total of 82 sessions were included. Over a series of simulation sessions that were conducted for each pediatric ward with repeated code sessions, the ward nursing staff showed significant improvements in initiating CPR, with a faster CPR initiation time. ConclusionsIn situ code simulation is a helpful way to enhance team performance and improve the quality of cardiac resuscitation. The CPR initiation time was greatly improved by continuous code simulation training for the code team.

How Prepared Are Pediatric Residents for Pediatric Emergencies: Is Pediatric Advanced Life Support Certification Every 2 Years Adequate?

Objectives. We assessed pediatric residents’ retention of knowledge and clinical skills according to the time since their last American Heart Association Pediatric Advanced Life Support (AHA PALS) certification. Methods. Sixty-four pediatric residents were recruited and divided into 3 groups based on the time since their last PALS certification, as follows: group 1, 0 to 8 months; group 2, 9 to 16 months, and group 3, 17 to 24 months. Residents’ knowledge was tested using 10 multiple-choice AHA PALS pretest questions and their clinical skills performance was assessed with simulation mock code scenarios using 2 different AHA PALS checklists, and mean scores were calculated for the 3 groups. Differences in the test scores and overall clinical skill performances among the 3 groups were analyzed using analyses of variance, χ2 tests, and Jonckheere-Terpstra tests. Statistical significance was set at P < .05. Results. The pediatric residents’ mean overall clinical skills performance scores declined within the first 8 months after their last AHA PALS certification date and continued to decrease over time (87%, 82.6%, and 77.4% for groups 1, 2, and 3, respectively; P = .048). Residents’ multiple-choice test scores declined in all 3 groups, but the scores were not significantly different. Conclusions. Residents’ clinical skills performance declined within the first 8 months after PALS certification and continued to decline as the time from the last certification increased. Using mock code simulations and reinforcing AHA PALS guidelines during pediatric residency deserve further evaluation.

Simulation for Clinical Preparedness in Pediatric Emergencies: A Pilot Study.

Positive outcomes for pediatric in-hospital cardiopulmonary arrest remain low with little change in mortality rates. Infrequently used clinical knowledge and skills decline quickly, contributing to poor quality of resuscitation. The aim of this pilot study exploring the outcomes of repeated pediatric mock code simulations with structured debriefing demonstrated statistically significant differences in participants' knowledge of pediatric emergencies, with no significant decline in resuscitation skills. This provides an evidence-based approach for professional development educators working with nurses on pediatric emergencies.

A Brain-Based Instruction Simulation Approach to Improve Code Team Response in an Internal Medicine Unit

Background and Objectives. The code team course is a 3-hour, interactive course that follows a 4-phase brain-based lesson plan for simulation. Interprofessional teams receive instruction and practice in evidence-based teamwork, communication, and individual skills. Methods. This quantitative research included a pre-test and post-test design in an urban Department of Medicine. Sixteen groups (n=109) participated in the course over a period of eight weeks. Classroom metrics included pre- and post-course High-Quality cardiopulmonary resuscitation (CPR) and code team didactic knowledge assessed by Wilcoxon rank-sum tests. In addition, four in-situ mock code simulations were conducted to provide the researchers with baseline and post-intervention data. Code team performance assessment scores were tallied and compared between baseline and post-intervention by Fisher’s Exact Test. Results. The classroom metrics produced significant results. High-Quality CPR scores were higher post-training than pre-training (median score 4 vs. 3, respectively; p=0.006). Didactic knowledge test scores were also significantly higher (median score 90 vs. 70, respectively; p &lt;0.001). In-situ team performance improved in several areas. There was a significant improvement in the area of cardiac code management in the day shift group. The percent “done well” improved from 25% (5/20) to 100% (20/20) (p= &lt;0.001). Conclusion. The results of this pilot study suggest that code team training using the 4-phase BBL plan for simulation is associated with improvements in interprofessional team knowledge and performance during cardiac emergencies. It is equally important that the training is conducted over a short period in order to ensure that all team members are properly prepared.

Examining Self-Efficacy and Self-Esteem in Healthcare Students Participating in an Interprofessional Critical Care Simulation

BACKGROUND: Interprofessional education (IPE) is becoming increasingly encouraged in healthcare. However, a lack of consensus exists in how IPE should be provided. The research at hand examines changes in self-efficacy and self-esteem in 132 nursing, dietetic, physician assistant, and social work students when participating in a critical care simulation. The simulation focused on a septic patient requiring cardiopulmonary resuscitation.METHOD: This quantitative, repeated measures and correlational study utilized the Generalized Self-Efficacy Scale and Rosenberg Self-Esteem Scale to examine a possible relationship between self-efficacy and self-esteem. In addition, exploration of changes in self-efficacy and self-esteem after participating in the cardiopulmonary simulation was conducted.RESULTS: There was a statistically significant medium, positive correlational relationship between self-efficacy and self-esteem in healthcare students participating in a cardiopulmonary resuscitation simulation (p&amp;lt;0.001). Healthcare students did not experience statistically significant gains in self-efficacy and self-esteem (p&amp;gt;0.05). During debriefing, students expressed experiencing role confusion when working with each other.CONCLUSION: More IPE experiences, including in mock code simulations, is necessary to enhance communication, collaboration, and prevent role confusion.HIGHLIGHTS:More interprofessional education is necessary to prevent role confusionSelf-efficacy and self-esteem have a positive correlation in IPE critical care simulationHealthcare students did not have significant gains in self-efficacy and self-esteem

Distributed Learning: Revitalizing Anesthesiology Training in Resource-Limited Ethiopia.

Ethiopia has a significant paucity of available health-care workers. Despite the increasing number of medical schools, there are not enough physician instructors. Furthermore, availability and standardization of postgraduate training are lacking. Modalities of e-learning have been shown to be successful when used to impart medical education in other resource-limited countries. The Emory University and Addis Ababa University (AAU) Departments of Anesthesiology have formed a collaboration with the intent of improving the AAU Anesthesiology residency program, one of two postgraduate training programs for anesthesiology in Ethiopia. An initial educational needs assessment identified areas in the existing training program that required improvement. In this pilot study, we describe how the current classroom-based curriculum is augmented by the introduction of interactive educational sessions and distributed learning in the form of video lectures. Video lectures covered topics based on areas identified by Ethiopian residents and faculty. Interactive sessions included hands-on ultrasound workshops and epidural placement practicums, a journal club, problem-based learning sessions, and a mock code simulation. Assessment of the additions of the newly introduced blended learning technique was conducted via pre- and posttests on the topics presented. Pre- to posttest score averages increased from 54.5% to 83.6%. An expansion of educational resources and modes of didactics are needed to fill the gaps that exist in Ethiopian anesthesiology training. Incorporating distributed learning into the existing didactic structure may lead to more efficacious instruction resulting in a higher retention rate of information.

Mock Code: A Code Blue Scenario Requested by and Developed for Registered Nurses.

The use of simulation in medical training is quickly becoming more common, with applications in emergency, surgical, and nursing education. Recently, registered nurses working in surgical inpatient units requested a mock code simulation to practice skills, improve knowledge, and build self-confidence in a safe and controlled environment. A simulation scenario using a high-fidelity mannequin was developed and will be discussed herein.

Education: The Impact of Mock Code Simulations in Pediatrics

Background: Mock code simulation is an area of practice that is growing throughout health care. Numerous references support the validity of this method of education. However, what is lacking in these references is the effect mock codes have on nurses. Objective of Study: This project was conducted in a freestanding children's hospital in a PICU (pediatric intensive care unit). The facilitator aspired to learn the effect of interventions that measure teamwork, confidence, and comfort level among nurses. Methodology: Inthisprojectthenursesweregivenapretestandposttest to evaluate their attitudes and comfort level for different aspects of a code. Answers on the pretest were compared to posttest answers following the mock code simulation. Questions included comfort level with drawing up code medications, performing compressions, administering medications, documentation, debriefing, MD-RN communication, RN to RN communication, one MD leading a code, overall comfort in a code and mock codes help with real-life codes. Framework/Model: Patricia Benner's theory on novice to expert lays the foundation for moving nurses effectively through mock code scenarios by providing firsthand experience with high-risk situations. The objective in a mock code is to move a nurse further along this model towards an expert nurse.

Evidence-based Practice: Prep for Success: How to Best Prepare Skin Before Capillary Blood Glucose Checks

Background: Mock code simulation is an area of practice that is growing throughout health care. Numerous references support the validity of this method of education. However, what is lacking in these references is the effect mock codes have on nurses. Objective of Study: This project was conducted in a freestanding children's hospital in a PICU (pediatric intensive care unit). The facilitator aspired to learn the effect of interventions that measure teamwork, confidence, and comfort level among nurses. Methodology: In this project the nurses were given a pretest and posttest to evaluate their attitudes and comfort level for different aspects of a code. Answers on the pretest were compared to posttest answers following the mock code simulation. Questions included comfort level with drawing up code medications, performing compressions, administering medications, documentation, debriefing, MD-RN communication, RN to RN communication, one MD leading a code, overall comfort in a code and mock codes help with real-life codes. Framework/Model: Patricia Benner's theory on novice to expert lays the foundation for moving nurses effectively through mock code scenarios by providing firsthand experience with high-risk situations. The objective in a mock code is to move a nurse further along this model towards an expert nurse. Results: The findings of this study hold promise that pediatric mock code simulation increases the overall comfort level of registered nurses. There was statistical significance (pb0.05) in two areas that were surveyed. • Nurse confidence in drawing up medications during a code • Nurse perceptions that mock code experiences help with reallife codes Conclusion: Pediatric mock code simulation is an effective tool to utilize in the pediatric setting. Teamwork, collaboration and communication are positively affected by code proficiencies. Simulation is an area to practice safe nursing skills and increases nurses comfort and confidence in reallife situations. View a PDF of this poster presentation at http://www.pedsnurses.org/d/ do/855. http://dx.doi.org/10.1016/j.pedn.2015.06.018 Evidence-based Practice: Prep for Success: How to Best Prepare Skin Before Capillary Blood Glucose Checks Ruth Jacobson BSN, RN, Sanje Woodsorrel BSN, RN Children's Hospital Los Angeles Abstract Practice Problem:Many inpatient pediatric patients require capillary blood glucose measurements to appropriately monitor glucose levels and allow for prompt response if needed. Variations in site preparation and collection of the sample may interfere with the accuracy of these findings and potentially result in under or overdosing of insulin or glucose, as well as increased pain and risk of infection for the patient. Purpose: What is the best practice for site preparation during point of care glucometer use?Practice Problem:Many inpatient pediatric patients require capillary blood glucose measurements to appropriately monitor glucose levels and allow for prompt response if needed. Variations in site preparation and collection of the sample may interfere with the accuracy of these findings and potentially result in under or overdosing of insulin or glucose, as well as increased pain and risk of infection for the patient. Purpose: What is the best practice for site preparation during point of care glucometer use? Summary of Literature: Variation was noted in policy between hospitals in the Los Angeles area, and evidence-based research on best practices to promote accurate measurements was examined using the Johns Hopkins Nursing Evidence-Based Practice Model: Diabetes educators were consulted. Hospital policy on glucometer use, as well as glucometer user manuals was reviewed. Additionally, variation in results between first and second drops of blood was compared. Finally, an informal study was conducted to determine any variation in results based on site preparation. Outcomes: Current research recommends washing the hands with soap and water and thoroughly drying for the most accurate glucometer readings. Use of alcohol wipes prior to lancing has 812 Selected Abstracts from the 2015 SPN Conference