Archive January 2020 XXI, No. 1

Safety: Simulate Emergencies in Bedside Mock Drills

Let staff practice their response to urgent situations before they occur

Michael Kost

Michael Kost, DNP, CRNA, CHSE

BIO

SIMULATING EXPERIENCE
OrthoNY Surgical Suites
SIMULATING EXPERIENCE With the help of a CPR skills training torso, GI staff participate in simulated mock code emergency drills at Einstein Endoscopy Center in Blue Bell, Pa.
In the months before our new GI center opened, we conducted a series of simulations in the patient care area to assess staff response to emergencies — before they occurred. To make the experience authentic, we brought a CPR skills training torso to the unit so staff could use the mannequin in their work environment with the equipment they regularly use. During the simulations, we identified 3 areas for improvement that facility leaders at Einstein Endoscopy Center in Blue Bell, Pa., resolved before they welcomed their first patients in February 2019.
  • Emergency call bell. We measured staff response time to the mock code. How long did it take staff to push the emergency response button, get the crash cart and administer the first dose of epinephrine? During the first simulation, there was nearly a 60-second delay in pushing the emergency button because it wasn't clearly visible to staff. Turns out light from the procedure room camouflaged the silver wall plate with its reflection. The GI center responded by placing a hard-to-miss 4-inch by 3-inch red plate above the emergency response button.
  • Procedure room defibrillator. During our first mock code response drill, staff needed instruction on how to use the new model defibrillator on the crash cart. Simulation center staff and the ACLS instructor conducted in-service sessions at the GI center to familiarize staff with the additional features on the defibrillator.
  • CPR. To enhance CPR quality delivered during mock code emergency response drills — specifically, increasing CPR depth, rate and recoil by 10% to 15% — the endoscopy center ordered a step stool to assist providers in delivery of CPR during mock code drills. The impact of a step stool on cardiopulmonary resuscitation? Deeper chest compressions, especially for shorter rescuers. Due in large part to the step stool, CPR metrics improved during the second and third mock code drills. The simulator measured rate and depth, helpful because most people don't push hard or fast enough when performing CPR.
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