A new nurse walks into a hospital room to find her patient, John Doe, grasping his chest and saying, “I can’t breathe, please help me!” Shortly after, Mr. Doe loses consciousness. The nurse caring for him tries to wake the man to no avail, “Sir, can you hear me?”
With her heart racing, she has to think fast about to do next. She calls out to other staff on the hospital room floor, “I need help in here. Mr. Doe is not breathing!” A code team responds, determines the patient has possibly had a heart attack, and acts appropriately.
This is a frequent scenario Jump simulates within its own walls as well as in hospitals throughout the OSF HealthCare System. You never want a situation where members of a care team are unsure of what to do when faced with a critically ill patient. Our mock codes help providers of all levels familiarize themselves with the process and ensure they are following the necessary steps to save patients’ lives.
As more hospitals and newly-developed simulation centers look to develop their own curriculum for mock codes, we thought it would be beneficial to share some of our best practices.
One Size Doesn’t Fit All
It’s important to note there are numerous types of mock codes medical facilities can run. Those that take place at Jump are based on the curriculum developed by faculty within University of Illinois College of Medicine at Peoria as well as clinical educators from OSF. Here are some things facilitators must consider as they put together their curriculum for mock codes:
Who are the learners (medical students, residents, RNs, paramedics, etc.)?
Who is the patient (baby, infant, child, adult or elder)?
What should this learning group be able to achieve (activating a code blue, using a defibrillator, CPR, administering medications, etc.)?
What are the learning objectives (how long does it take a clinician to recognize a patient is in cardiac arrest, how long does it take to begin chest compressions after a patient goes into cardiac arrest, was CPR continuous or interrupted, etc.)?
The most common type of code we conduct is for an adult patient who has experienced a cardiac event resulting in ventricular fibrillation (the heart can’t pump any blood, pulseless) or ventricular tachycardia (fast heart rate).
The learners are most likely a team of nurses and residents certified in Basic Life Support. They should be able to activate a code blue, start chest compressions, deliver ventilations, and operate a defibrillator.
Setting up the Mock Code
The space where you conduct a mock code must mirror where an actual code would take place to assist in enhancing the realization of the case. The simulation specialists at Jump set up our virtual medical rooms with everything a code team would need in the event of an emergency based off both the nature of the emergency and learning objectives designed by the facilitator.
The room is typically equipped with an adult bed, bedside table, and phone to call for a consult. There would also be a crash cart stocked with appropriately labeled medications, a defibrillator, an extra bag of fluids hanging next to the bedside for future use, and oxygen supplies.
The mock code can be performed on a low or high fidelity manikin that displays EKG, heart rate, blood pressure, ETCO2, etc. A high fidelity model will have more pulse points, chest rise and fall, and collect statistical and real-time data. However, you really just need a manikin with a pulse for a simple mock code.
Running the Code
The educator who developed the curriculum is on-site, behind the scenes evaluating how the team performs. Our simulation specialists operate the entire simulation with the guidance of the facilitator.
Before learners are thrown into a mock code, they are briefed on the room set-up and how the manikin works. Then they are asked to leave the room and come back within one minute when the scenario will begin.
Up to four residents or nurses will walk into the hospital room to either find their patient pulseless, or awake and complaining of chest pain and shortness of breath. The patient’s condition quickly deteriorates to where he/she becomes pulseless and unresponsive.
The learners are expected to perform as though it’s a real situation. In this case, they would be expected to immediately call a code blue, analyze their patient’s vitals like heart rhythm, start chest compressions, insert an IV and use a defibrillator if needed. Meanwhile, the educator is observing the team’s performance. He/she may be timing how long it takes to start chest compressions after cardiac arrest or whether there were interruptions in CPR. He/she could also be watching the team dynamics of communication.
The simulation specialists behind the scenes will likely leave the manikin in a pulseless state until the educator determines the team has followed their learning objectives. The code can take up to ten minutes depending on the steps the learners take to revive their patient. Once the care team is finished with their simulation, they will enter into debriefing with their facilitator.
Mock Code Debrief
Debriefing is the most important part of any simulation. In the case of a mock code, an educator will give feedback on the team’s performance based on the learning objectives generated in the curriculum. However, a good debrief is one that is driven by the learners themselves. Allowing for self-evaluation means the educator may never have to say anything because the learners identified what they did well and where they can improve.
The goal is to ensure our learners are completely prepared before they are faced with a real code blue situation. We want learners walking out of our facility feeling confident and most importantly, equipped to save lives in a fast and efficient manner.