All Clear: Improving the Code Process


Poster Presentation

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 that used the concept of simulation-based learning.

Proposed Change

For the past 5 years our facility used simulation-based learning that focused on high-risk obstetric 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 a hands-on approach, which focused on documentation, communication, full use of the defibrillator, and crash cart knowledge.

Implementation, Outcomes, and Evaluation

Because maternal codes are rare, staff were not comfortable with the different aspects of the defibrillator/automated external defibrillator (AED). In addition, staff were not accustomed to using 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 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 of speaking 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 the EKG strip from the defibrillator, change from AED mode to defibrillator mode, increase joules as requested, draw up code medications, retrieve any necessary equipment or supplies from the crash cart, prepare for a STAT bedside delivery, document the code events, and communicate appropriately to the 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

When applying the science of simulation by creating a unique learning experience, nurses’ confidence level, knowledge, and skills in recognizing the signs and symptoms of AFE can be improved. The use of simulation also improves the nurses’ ability to use the defibrillator, draw up code medications, serve as documenter, and effectively use closed-loop communication in a code situation.