Bringing a Code Blue to You

Cardiac arrests are rare medical emergencies in the primary care setting, but prompt, coordinated intervention is essential. In a large health system in the Midwest, despite annual competency assessment, nurses reported feeling unsure of their role in a “code blue.” Annual medical emergency response competency assessments are held in conference rooms and nurses are evaluated individually. While this model promotes efficiency for the thousands of nurses who complete this competency, it does not increase the confidence of nurses to find the equipment on their unit or to learn their role as a code team member. The team of primary care nursing education specialists conducted a learning needs assessment in November 2021. The findings of the learning needs assessment supported our assumptions:
1) Nurses value hands-on in-situ practice.
2) There is anxiety about the preparation and ability of their colleagues to respond to emergencies.
3) There is anxiety about roles when managing a medical emergency.
4) There is uncertainty about how and where to obtain medical emergency supplies in their work settings.
A literature search revealed that the results of the learning needs assessment were not unique - uncertainty regarding roles and teamwork in a medical emergency is common among nurses. The literature search also found that in-situ simulations alleviated some of that anxiety and improved performance. In response to what was found with the learning needs assessment and the literature, conducting in-situ simulations was the necessary next step. The education team consists of seven nursing education specialists, who cover approximately 1,000 nurses in over 25 practice sites in 18 different cities in 3 states. A “champion” model was employed. Each work area recruited expert staff nurses to serve as “champions” to disseminate education to the rest of the unit, for a total of 38 champions across primary care. In Spring 2022, 4 hours of initial education were provided to the champions. The first class was held virtually for two hours explaining the champion role and providing education on principles of simulation education. The second class was held in person for hands-on practice of the code blue scenario and simulation equipment. Following the education, champions held mock codes on their units throughout the summer with a goal of 80% participation. An evaluation will be completed when the simulations conclude. Nurse managers and staff nurses have shared that the simulations have been well-received. The champions have enjoyed the leadership position, and this has offered a professional development opportunity for expert clinicians. One of the clinics had a code blue the day after the staff had simulations. The nurses were confident and handled the emergency smoothly. Next steps include simulation for other emergencies common in primary care, including anaphylaxis, hypoglycemia, and behavioral emergencies.