DESCRPTON/OVERVEW ock Codes provide learning opportunities and play an integral part of clinical readiness for patient emergencies. Holding mock cardiac/respiratory arrests or code situations may expose common failures and gaps in knowledge in rapid response with CPR and other life-saving care. ock codes also set up powerful incentives to sharpen emergency skills and provide immediate learning/training opportunities. The goal is to practice skills, expand knowledge and build self confidence in a safe and controlled environment. REFERENCES GET WTH THE GUDELNES. (2017, ay). Resuscitation Fact Sheet. Retrieved October 10, 2017, from American Heart Association: https://www.heart.org/idc/groups/heartpublic/@private/@wcm/@hcm/@gwtg/documents/downloadable/ucm_434082.pdf ock Code Blue Scenario Requested by and Developed for Registered Nurses. Cureus. 2016 Dec; 8(12): e938. Published online 2016 Dec 23. doi: 10.7759/cureus.938. Kerry-Lynn Williams, Janice Rideout, Sherry Pritchett-Kelly, elissa cdonald, Paula ullins-richards, and Adam Dubrowski AREAS OF RESPONSBLTY This guideline applies to all areas that provide patient care. The Unit Director ensures that all licensed staff, giving direct patient care, has an opportunity to participate in a mock code. GUDELNE STEPS 1. Each unit will critique four (4) code incidents per year. An incident is defined as an actual code or a mock code. The critique form will be completed for either type of incident and kept on file for three (3) years. 2. The unit director or designee is responsible for ensuring four (4) critiques are done per year and documented. Units may do more than 4 mock codes per year. f not already addressed during the event, an improvement plan will be formulated, completed, maintained with the critique, and relayed to staff within ten (10) days. However, no improvement plan is required if remediated at the time of the critique and relayed to staff directly. SUARY OF CHANGES New Document, 7/2018 Applies To: UN Hospitals Responsible Department: CPR Committee Effective Date: 07/2018 Guideline Patient Age Group: ( ) N/A (x ) All Ages ( ) Newborns ( ) Pediatric ( ) Adult RESOURCES/TRANNG Resource/Dept Departmental UBEs & Clinical Education Contact nformation Per Unit Based Educators Page 1 of 13
DOCUENT APPROVAL & TRACKNG tem Contact Date Approval Owner CPR Committee: Chair Dr. Erik P Kraai Consultant(s) CPR Committee embers Committee(s) CPR Committee, UNH PP&G Committee, Nurse Practice PP&G Subcommittee Y Nursing Officer Sheena Ferguson, Chief Nursing Officer Y edical Director/Officer Erik P Kraai, D & Assistant Professor, Critical Care Y Official Approver Sheena Ferguson, SN, RN, CCRNr, CNS, CNO Y Official Signature On SharePoint Date: 07/19/2018 Effective Date 07/19/2018 ATTACHENTS A. Pediatric Code Critique Form B. Adult Code Critique Form C. Neonatal Code Critique Form D. Ambulatory Code Critique Form E. UPC Code Critique Form F. aternal Code Critique Form Page 2 of 13
A. Pediatric Code Critique Form Actual ock Date: Code Responsibility Yes/No/NA Comments/Action Was the response appropriate? Response time Did adequate staff respond or available? Was the call for help initiated? PCU code phone (GPU, CT, PSCU) PCU unit called (Peds clinic only) Was airway correctly assessed? Was suction set up correctly? Was the need for an airway adjunct assessed? f yes, correctly chosen? Age/size appropriate? Was oxygenation status correctly assessed? Was adequate O2 delivery system chosen? Was the initiation of BV age/size appropriate? Was BV correctly assembled? (includes pulling reservoir completely out) Was BV correctly placed on patient? Was there an assistant with BV management? Was patient bagged at correct rate? Was there adequate flow through O2 delivery device? Was there effective chest rise? Were pulses and perfusion correctly assessed? Was intervention appropriate for pulselessness? Were chest compressions performed correctly? (adequate to generate pulse, correct rate?) Was there an assist/back up with chest compression? Was a pulse reassessed after compressions? Was the backboard placed appropriately? Was shock recognized? Was shock appropriately managed? Were vitals taken appropriately? Were defibrillator pads correctly placed on patient? Was monitor turned on? Correct cardiac rhythm identified? Was appropriate intervention instituted? Were strips run? Prior rhythm known? History obtained? One touch/labs obtained? Was temperature obtained? Was current V/O access assessed? nitiated? Was a second V access initiated? Was crash cart brought to room and plugged in? Were all roles appropriately delegated? Leader Recorder ed nurse onitor person Was patient s primary nurse available? Was patient s family notified/ taken care of? Did Physicians arrive promptly? Was a report given to oncoming staff? Was PPE used by everyone? Did staff treat mock code as the real situation? Page 3 of 13
B. Adult Code Critique Form ACTUAL: OCK: DATE: TE: Code Responsibility Yes/No/NA Comments Was the response appropriate? Response time: Did adequate staff respond? Was the call for help appropriate? f Dr. Heart, was it heard overhead? Was a pulse correctly assessed? Was intervention appropriate for pulselessness? C Were chest compressions performed correctly?(adequate to generate pulse) Was there an assist/back up with chest compression? Was a pulse reassessed after compressions? Was the backboard placed appropriately? A Was airway correctly assessed? Was oxygenation status correctly assessed? Was the initiation of BV appropriate? B Was BV correctly assembled? (includes pulling reservoir completely out) Was BV correctly placed on patient? O S C. Was there an assist with BV placement? Was patient bagged at correct rate? Was there an effective chest rise? Was oxygen set up correctly? Was the appropriate oxygen delivery system used for the situation? Were vitals taken appropriately? Were Zoll pads correctly placed on patient? Was monitor turned on? Were strips run? Was current V access assessed? Was a second V access initiated? Was crash cart brought to room? Was suction set up correctly? Were all roles appropriately delegated? Leader Recorder ed nurse onitor person Was PPE used by everyone? Was patient s primary nurse available? Was patient s family notified/ taken care of? Did Physicians arrive promptly? f ock Code, did staff treat as the real situation? Today s Date: Time: Staff Participants Page 4 of 13
Educators: What was addressed? CODE DEBREFNG What concerns were reported by staff? Page 5 of 13
Response Airway C. Neonatal Code Critique Form DATE: TE: Reviewer: Unit: inutes and Points <1 min=2 pts <2 min=1 pt <3 min=0 pts Appropriately responded to code/initiated code (once help or code is needed based on your assessment) Vital Signs Assessed Correct code phone used or Code Blue button pressed (wall NBCU/ CN 4) white phone ( CN 3/NBN/L&D/WSC) Crash Cart obtained Additional RNs arrival RT arrival D/NNP/PA arrival Oxygenation source and suction set up Airway correctly assessed (R SOPA utilized) Suction used is needed and suction pressure appropriate Breathing ntubation Circulation Oxygenation/Breathing correctly assessed (Supplemental O2, BV, Auscultation) Correctly initiated PPV/ntubation if indicated Correct T Piece Resuscitator Set up (Correct initial PP, PEEP, and FiO2) Correct size mask used and held correctly on patient s face PPV given at appropriate rate and pressures Effective Chest Rise Heart rate correctly assessed EKG leads placed TOTAL POSSBLE PONTS FOR NTAL STEPS OF NRP /36 Correct Sized intubation blade used Correct Sized ET tube used for weight and gestational age ET tube inserted to appropriate depth Pedicap CO2 detector used to confirm placement Chest auscultated and chest rise noted following intubation Chest Compressions performed correctly (used correct thumb) Compressed at correct depth Compressor called out One-and-Two-and-Threeand-Breathe-and to ensure 3:1 ratio at correct pace *BONUS* Cardiac board used if patient in crib Yes=2 pts Yes=2 pts No=0 pts No=0 pts Yes=2 pts No=0 pts Page 6 of 13
V Access eds isc. Current V assessed or new line placed Correct supplies assembled to insert Umbilical line Right dose of given Epinephrine given via correct route Epinephrine drawn up and administered correctly with appropriate saline flush if indicated edications correctly documented on Code Sheet *BONUS* Other medications administered correctly: (2 extra points per each med) Saline Bolus Narcan Adensoine Sodium Bicarb Each team member role identified: RN Code Leader Recorder Airway ed Nurse Compressions onitor person PPE used by everyone Team communication effective Code sheet completed correctly Staff treated ock Code as real Code TOTAL POSSBLE PONTS FOR SC SESSON /20 Yes=2 pts Yes=2 pts No=0 pts No=0 pts Combined Total Score for nitial NRP Steps and SC Section (Required for every ock Code) /56 Total Possible Score For all Sections /82 Today s Date: Time: Staff Participants Evaluators: Page 7 of 13
Code Debriefing What went well? What did not go well? How was the communication? Areas scored 0: Other observations, comments, concerns: Page 8 of 13
C A B O S C. D. Ambulatory Code Critique Form ACTUAL: OCK: DATE: TE: Code Responsibility Was the response appropriate? Response time: Did adequate staff respond? Was the call for help appropriate? f Call 911, was it timely? f Dr. Heart, was it heard overhead? Was a pulse correctly assessed? Was intervention appropriate for pulselessness? Were chest compressions performed correctly?(adequate to generate pulse): 30 2 100/min Was there an assist/back up with chest compression? (switch after 2 minor 5 cycles) Was a pulse reassessed after compressions? Was airway correctly assessed? Was oxygenation status correctly assessed? Was the initiation of BV appropriate? Was BV correctly assembled? (reservoir completely out) Was BV correctly placed on patient? Was there an assist with BV placement? Was patient bagged at correct rate? (10 12 breaths/min) Was there an effective chest rise? Was oxygen set up correctly? Was the appropriate oxygen delivery system used for the situation? Were vitals taken appropriately? (BP/Palpated) Were AED pads correctly placed on patient? Was AED turned on? Was current V access assessed? Was BLS Kit brought to area? Was suction brought and set up correctly? Were all roles appropriately delegated? Leader Recorder BLS persons Family Attendant, Traffic Person, 911 Guide Was PPE used by everyone? f ock Code, did staff treat as the real situation? Yes/No/ NA Comments Today s Date: Time: Staff Participants: Charge Nurse: Educator/Provider: Page 9 of 13
A B C O S C E. UPC Code Critique Form ACTUAL: OCK: DATE: TE: npt/outpt npt/outpt RRT RRT RRT RRT RRT Code Responsibility Was the response appropriate? Response time: Did adequate staff respond? Was the call for help appropriate? 333 Was airway correctly assessed? Was oxygenation status correctly assessed? Was the initiation of BV appropriate? Was BV correctly assembled? (includes pulling reservoir completely out) Was BV correctly placed on patient? Was there an assist with BV placement? Was patient bagged at correct rate? Was there an effective chest rise? Was a pulse correctly assessed? Was intervention appropriate for pulselessness? Were chest compressions performed correctly?(adequate to generate pulse) Was there an assist/back up with chest compression? Was a pulse reassessed after compressions? Was the backboard placed appropriately? Was oxygen set up correctly? Was the appropriate oxygen delivery system used for the situation? Were vitals taken appropriately? Were AED pads correctly placed on patient? Was AED turned on? Were Zoll pads correctly placed on patient? Was monitor turned on? Were strips run? Was current V access assessed? Was a second V access initiated? Was crash cart/bls brought to room? Was suction set up correctly? Were all roles appropriately delegated? Leader Recorder ed nurse onitor person Was PPE used by everyone? Was patient s primary nurse available? Was patient s family notified/ taken care of? Did Physicians arrive promptly? f ock Code, did staff treat as the real situation? Yes/No/NA Page 10 of 13
Today s Date: Time: Staff Participants RRT: What was addressed? CODE DEBREFNG What concerns were reported by staff? Page 11 of 13
A F. aternal Code Critique Form ACTUAL: OCK: DATE: TE: Code Responsibility Type of Code: Ex. PPH< Prolapse Cord, gso4, etc. Was the response appropriate? Response time: Did adequate staff respond? Was the call for help appropriate? f Dr. Heart, was it heard overhead? Was airway correctly assessed? Was oxygenation status correctly assessed? Yes/No/ NA Comments Was the initiation of BV appropriate? B C O F Was BV correctly assembled? (includes pulling reservoir completely out) Was BV correctly placed on patient? Was there an assist with BV placement? Was patient bagged at correct rate? Was there an effective chest rise? Was a pulse correctly assessed? Was intervention appropriate for pulselessness? Were chest compressions performed correctly?(adequate to generate pulse) Was there an assist/back up with chest compression? Was a pulse reassessed after compressions? Was the backboard placed appropriately? Was patient s abdomen (uterus) displaced to the left? Was oxygen set up correctly? (includes appropriate delivery system) Were vitals taken appropriately? Were Zoll pads correctly placed on patient? Was cardiac crash monitor turned on? Were strips run? Was current V access assessed or initiated if no V? Was a second V access initiated? Was fluid bolus of LR initiated? Was contributing factor* correctly identified? Were interventions correctly initiated? (Porlapsed cord, hemorrhage pack, delivery tray) Was NCU notified correctly for delivery and location? Was NRP initiated by staff prior to NCU arrival? Was the NeoPuff assessed for appropriate settings? Was immediate emergency cesarean section performed if no ROSC within 4 minutes of maternal arrest? (Goal time within 5 minutes of arrest) Page 12 of 13
S C. Was crash cart brought to room? Was suction set up correctly? Were all roles appropriately delegated? Leader Recorder ed nurse onitor person Was PPE used by everyone? Was patient s primary nurse available? Was patient s family notified/ taken care of? Did Physicians arrive promptly? f ock Code, did staff treat as the real situation? *Possible Contributing factors: Bleeding/DC, Embolism, Anesthetic complications, Uterine atony, Cardiac disease, Hypertension/Pre-Eclampsia/Eclampsia, Other ACLS diagnosis, Placental abruption, and Sepsis. Today s Date: Time: Staff Participants: Educators/Charge Nurses: What was addressed? CODE DEBREFNG What concerns (positive or negative) were reported by staff? Page 13 of 13