Traditional Poster Round
Context: : The Pediatric Intensive Care Unit (PICU) is high risk for codes and resuscitations, occurring in 9.4 of every 1000 critical care patients.1 PICU nursing and multidisciplinary staff must have an exceptional understanding and performance of Pediatric Advanced Life Support (PALS) to optimize resuscitation. The primary purpose of this project was to improve the quality of pediatric resuscitations in the PICU and optimize patient outcomes by addressing teamwork, nursing confidence and anxiety, and efficiency and accuracy of resuscitation. 2
Description: : A multidisciplinary Mock Code Committee was created to implement a series of in-situ mock codes within a PICU in a 440+ bed free-standing tertiary urban pediatric medical center in the southwestern United States. Scenarios were extracted from the PALS provider manual and the Mock Code Committee created a list of goals and objectives based on PALS guidelines. The committee created a checklist of supplies and delegated responsibilities for set up and take down, for the lead PALS provider, and for debriefing. Prior to implementation, the team practiced each scenario. One PALS scenario was chosen per quarterly implementation for simulation. The committee set up a simulation mannequin in a PICU bed space and clinical staff responded to the “patient’s” change in status accordingly. Staffing was provided by the committee to cover nursing staff during mock codes to ensure unit safety. Unit secretaries, providers, nurses, managers, and chaplains all participated in the mock codes. Upon completion of the scenario, the committee provided education and feedback through the DISCERN debriefing tool. 3 Further education was disseminated after each quarterly scenario implementation through email, posters, and one-on-one review.
Observation/Evaluation: : Data collection consisted of survey results pre- and post-intervention to evaluate nursing self-efficacy and confidence. Surveys revealed 10% increase in nursing confidence. Team performance improved by 49% according to the TeamSTEPPS form. PALS guidelines were utilized to evaluate data extracted from patient charts to observe accuracy in resuscitation in the PICU. There was a 24 % increase in PALS accuracy for patient resuscitations according to patient code sheets.
Discussion: : The innovation accomplished a strong foundation for resuscitation in the PICU. Clinical staff surveys voiced the positive impact of in-situ mock codes with unanimous support to continue the codes quarterly, supplementing annual simulation lab check offs. The medical director of the PICU lead a resuscitation on the unit one hour after a mock code and expressed that it was one of the best run codes, attributing its success to the mock code intervention. Within the positive review of the resuscitation, the director most appreciated role clarity, nurse confidence and timeliness, as well as accuracy of interventions. Further study and implementation would benefit the simulation community as it demonstrates in-situ simulation. The PICU has continued these in-situ pediatric mock codes on a quarterly bases over the past 15 months because they recognize the indispensable value of simulation at the bedside.