All Clear: Improving the Code Process

Purpose for the program:

The Simulation facilitators at Baylor University Medical Center recognized the need to create best practice surrounding maternal codes, therefore a new process for annual Mock Code was developed utilizing the concept of Simulation-based learning.

Proposed change:

For the past 5 years our facility has utilized simulation-based learning focusing on high risk obstetrical events; however we still performed Mock Codes on the unit in a didactic type format with skills check-off. Following a maternal code on our unit, we incorporated simulation concepts with its hands-on approach, focusing on documentation, communication, full utilization of the defibrillator, and crash cart knowledge.

Implementation, outcomes and evaluation: Since maternal codes are rare, staff are not comfortable with the different aspects of the Defibrillator/AED. In addition to their discomfort with the defibrillator, staff were not accustomed to utilizing the code documentation sheet. The Perinatal Simulation Team developed an Anaphylactic Syndrome of Pregnancy or Amniotic Fluid Embolism (AFE) scenario and recorded it. Using this video, we were able to debrief our entire staff regarding the processes they viewed. Initially, we made them serve as the role of documenter and record what they observed as the video played. We then had them discuss and compare documentation to gain an understanding of the importance to speak up to ensure all necessary information is gathered during a code. Then we reviewed the tape again, this time debriefing the scenario and addressing teamwork, communication and technical skills. Following this discussion, we ran a simulation scenario that mimicked what they just watched. They had to perform CPR, place the pads from the defibrillator/AED and deliver shock as advised, print EKG strip from defibrillator, change from AED mode to defibrillator mode, increase joules as requested, draw up code meds, retrieve any necessary equipment or supplies from the crash cart, prepare for a STAT bedside delivery, document code, and communicate appropriately to medical team. Our training increased staff confidence, knowledge of the crash cart and defibrillator and awareness of communication needs during the maternal code.

Implications for nursing practice:

Applying the science of simulation by creating a unique learning experience,  the nurses’ confidence level, knowledge, and skills in recognizing the signs and symptoms of AFE, utilizing the defibrillator, drawing up code medications, serving as documenter, and effectively utilizing closed-loop communication in a code situation can be significantly increased.

Keywords:

Simulation

Maternal code

Safety

Anaphylactic Syndrome of pregnancy

Competencies