Are Your In Situ Simulations Meaningful for All?

By: Melanie Cason

Many in situ simulation experiences in medical facilities involve the deterioration of the patient into a cardio-pulmonary arrest. But mock codes have the reputation of being just that – mock. Usually a number of responders arrive quickly, leaders are identified and immediately play out their parts, and there is quick progression to ACLS.

In contrast, providing a situation that examines the crucial first five minutes with bedside medical-surgical staff provides the opportunity to identify needs for improvement. Individualized and team education for first responders on a medical unit is important to improve patient outcomes. But far from the complexity that occurs with advanced care, the first five minutes can determine the likelihood of successful resuscitation. The initial actions in a cardio-pulmonary arrest involve identifying the emergency, calling for assistance, providing compressions, defibrillating early, and providing airway management. In situ simulation for bedside staff may improve these actions (Herbers & Heaser, 2016).

The logistics of using high-fidelity simulation for in situ purposes can be daunting, and realism can be lacking with task trainers or static manikins. The practice of surprising staff by simply tossing a manikin in an empty bed and calling a code is questionable for a number of reasons. Technology allows for measurement and thoughtful consideration of training needs.

I was recently part of a team that addressed the need for measurement of the time it took to identify the emergency, call for help, start compresses, attach the defibrillator, provide ventilation, and achieve successful defibrillation. The education team was able to determine a baseline response level of staff, provide debriefing, and repeat the experience in order to improve response measurements. The following components were utilized, with minimal time required to set up and break down the simulation.

1. CPR Torso Manikin with quality feedback device for compressions and ventilations
2. Device linked to the unit defibrillator for rhythm alteration (ventricular fibrillation, cardiac arrest)

3. Computer tablet with programmed scenario for time stamping notification of emergency team, time to compressions, time to ventilation, and time to successful defibrillation (both pre- and post-actions were time stamped)

Preliminary data indicate significant improvement, particularly with time to defibrillation.

Team members on medical-surgical units need to be empowered with the knowledge and skill to avoid the classic trap: “The code team will do that when they arrive.” Although Basic Life Support incorporates Automatic External Defibrillator (AED) education, it is well documented that ongoing practice is important for maintaining competence (Meaney et al., 2013; Oermann, Kardong-Edgren, & Odom-Maryon, 2011). On units where the AED is rarely used, the result is a high-risk, low-volume patient safety issue. Dusting off the defibrillator, and remembering how to turn it on, is essential.