Mock Codes in the Pediatric Ambulatory Care Setting

Emergency medical events are historically a rare occurrence in the outpatient setting. However, as acuity and volume in outpatient pediatric clinics continues to rise, staff must be adequately prepared to respond to emergency events, perform life-saving interventions, and appropriately transition patients to a higher level of care. In hospital-based outpatient clinics, partnership with the inpatient code team is beneficial as it allows for efficient transition of care from medical assistants to code team caretakers. Developing the relationship between the team members within the two different settings is essential. A lack of education, knowledge, or communication can lead to poor outcomes for the patient and distress among staff members. Incorporating mock codes into the outpatient setting is an effective means to enhance hands-on and communication skills. The introduction of mock codes has allowed leadership to effectively identify learning needs, while also developing the nurse and medical assistant’s skill set. Pre-survey data showed that 74% of multidisciplinary staff, including techs, nurses, and medical assistants, felt uncomfortable in emergency medical situations. Many reported feeling uncomfortable in locating/using emergency medical equipment and the identification of their role during the emergency response. The initiation of mock codes following this survey has allowed for the development of staff’s skill set and confidence. This has also allowed for the identification of the need to bridge the gap between outpatient clinic staff and the code team responders. The outpatient setting differs significantly from the inpatient setting. Available resources, staff scope of practice, and the average acuity of the patient population creates the need for an altered response from clinic staff as well as the code team. Code team members are familiar with responding to the bedside for a patient who is already being cared for by a team of registered nurses. In the outpatient setting, code team members are met by a team of medical assistants whose scope of practice is more limited. Therefore, the code team must receive an efficient report and assume responsibility for medication administration, line placement, and decision-making. Building a partnership with the hospital code teams and ensuring medical assistant understanding of the importance of providing an effective patient report are therefore vital components to successful outcomes. Working to identify clear roles and expectations can lead to improved confidence, teamwork, and response. The introduction of mock codes in outpatient has helped to increase the effectivity and efficiency of staff response to emergency medical events while simultaneously improving the rapport between inpatient and outpatient staff. Post-survey data found that 94% of respondents felt positively regarding their ability to adequately respond to emergencies. Continuous evaluation of learning needs led to the creation of additional educational opportunities. Crash cart demonstrations, skill workshops, and enhanced mock code situations have allowed for continued development. The simulation experiences create a safe and controlled environment for staff to practice skills, ask questions, learn, and grow, while further improving patient care.