Title : On-site BLS mock drill: Enhancing nurses confidence and readiness in managing the cardiopulmonary resuscitation through a simulation based approach in a tertiary care hospital
Cardio Pulmonary Resuscitation (CPR) is the critical and sensitive approach which is adopted by health care professionals to save life of individual who suffer from cardio-pulmonary arrest. It require sound knowledge, competency, skills and presence of mind for being responsive in critical real time situation. To have successful certification, Health professional shall be thorough with basic of human anatomy and physiology, awareness of ECG and its arrhythmia, skills of Intravenous Line /Intra Osseous Lines and correct practice of hand placement with accurate depth of chest compression and bag-mask ventilation.
The resuscitation skills training is required to ensure health professionals manage event to restore life and to perform cardiopulmonary resuscitation (CPR) and external defibrillation timely when required. These concepts are delivered to health professionals through theory and demonstration based on the American Heart Association’s guidelines for Basic Life support (BLS) by trained AHA Instructor and in coordination with Nursing Team Clinical and Administration at Liaquat National Hospital Nursing Services Sub-Specialty Units.
To deal with any such life threating situation, an underprepared health care professionals are the most dangerous threat to patient survival in the intense and frightening environment of a code blue situation. Since the certification of basic life support certification required and mandate of health professionals on merely a biannual basis, it cannot be expected that nurses maintain the skills and knowledge without routine application. The use of mock code in site training, or “Code Drill” simulation, evaluates the strengths and weaknesses of the facility staffs have when dealing with emergent healthcare crisis such as a cardiac arrest or other cardiovascular events. Such mock code training with active participation and debriefing shall be an effective tool to fill in this gaps or grey areas experience by Nurses at LNH.
The aim of this quality improvement project was to enhance the confidence and the readiness of bedside nurses in managing the cardiopulmonary resuscitation through an effective team based approach via BLS Mock drills.
Mock code simulations were conducted over a period of three weeks for 125 Nurses with an emphasis on hands-on practice as well as teamwork and communication. The project utilized pre- and post-intervention surveys to document changes in self-reported nurse confidence in the various skills performed during a code blue. This measures build greater situational team awareness, enhanced interdisciplinary communication, leadership and mutual support which work to alleviate fears, uncertainties and role confusion during a code. When these issues are addressed, the functionality of the team increases and patient outcomes improve
Results showed significant improvement in self-reported nurse confidence after the mock code simulation. Insufficient survey responses and time constraints were identified as limitations to the project. Future recommendations include greater attention to defibrillation and inclusion of an extended debriefing period for self and team reflection. Further simulations should be maintained on a quarterly basis to ensure patient safety and nurse readiness in a code blue.
The application of simulated blue code scenarios on site has demonstrated its capability to enhance the staff performance and self-reported competency in crisis scenarios as well as a remarkable reduction in patient mortality. The success of our study provides proof of concept for further investment of time and resources in simulated crisis scenarios for better patient outcomes in other medical training programs.