Simulation-Based Education for a Code Blue Situation – Care Example

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"Simulation-Based Education for a Code Blue Situation" is a perfect example of a paper on care. In situations involving patients in cardiac arrest is stressful enough for medical staff therefore, requires the use of protocols learned in basic life support (BLS) and advanced cardiovascular life support (ACLS). Successful resuscitation is dependent on the effective implementation of these procedures by each member of the resuscitation team. However, on some occasions, team members are unaware or uncomfortable in performing certain duties during code blue events. This may be due to a number of factors such as the decrease in skills overtime or the lack of expertise.

Determining the rationale through code blue mocks helps in improving patient outcomes and competency. In addition, the use of patient simulation scenarios has been used to promote critical thinking, critical care, and teamwork among staff during medical emergencies. This strategy has been used extensively during training in code blue scenarios. Such mocks are used to increasing knowledge, confidence, and skills that later translate to better management of the patient during actual emergencies. The surprising benefit of in-situ mock education is the discovery of safety concerns that can be readily addressed later.

With the mock code blue drill, the challenge was for the staff to respond to a simulated cardiac arrest scenario. The nursing staff members are expected to call a code blue, initiate CPR and resuscitate the patient using their defibrillators and crush cart. The drill helps and gives the medical staff the opportunity to apply basic life support and advanced cardiac life support skills so as to develop an effective team and communication while at the same time gain experience with medical equipment used during medical emergencies.

Mock drills are used as tools for accessing system processes. An evaluation of the code performed in situ has helped in identifying problems and barriers that affect code performance and outcomes. Therefore, these have impacted staffing, arrangement of furniture, communication system, and issues concerning patient transport. This paper is a review of the performance of a code blue event that will identify areas of strengths and weakness relating them to the ARC guidelines. Reviewing the results of the video immediately apparent gaps in following protocols in basic life support (BLS) and advanced cardiovascular life support (ACLS) according to the ARC guidelines.

Several areas of poor performance were identified within the video clip. First, the nurse insight did not access the situation properly. Particularly, the nurse shook the patient to access the level of consciousness rather than use “ verbal or tactile stimuli” or use simple commands such as “ can you hear me” and“ squeeze my hand” . Under no circumstance should a nurse shake a patient to determine the level of consciousness in all emergency situations.

The nurse did not press the code bluebell behind the bed. In such a situation the nurse is trained to press the bell to call for help after realizing that the patient is unconscious. Failure do to so may result in poor response time and ineffective communications. Therefore, the need for a standard operating procedure. Morey et al, 2002 noted that have a standard operating procedure helps in reducing the error rate, improves team behavior and attitude. The nurse who administrates oxygen did not tilt the head and lift the chin.

When a patient is unconscious and lying on the back, the tongue is able to fall back blocking air from entering the lung. You open the airway by tilting their head back and lifting their chin with the other hand. But, if there are chances of injury just lift up the chin. Tilting the head could result in an injury to the spine or the neck resulting in further injury in the spinal column. Therefore, it is important for the unconscious victim care to perform a maneuver of titling the head and lift the chin (Zevitz, Plantz& Gossman, 2008) and (Guyette and Wang, 2015). The first nurse failed to airway clear of oral contents or foreign material.

The first nurse who did compression did not remove the pillow. Removing pillows can make the airway open easily (Zevitz, Plantz & Gossman, 2008) and (Guyette and Wang, 2015). The chest compression was inadequate. The lower half of the sternum should be depressed approximately one-third of the depth of the chest with compression. Poor proficiency of chest compression can reduce the quality of performance in code blue scenarios (Roh& Lim, 2013) and(Zou et al, 2015).

The nurse who did compression did not stop for a second to allow for ventilation. It is recommended that a universal compression-ventilation ratio of 30:2 (30 compressions followed by two ventilations). Compression must be paused to allow for ventilation (Chi, Tsou, & Su, 2010) (Zou et al, 2015) and (Li et al, 2015). The nurse who did compression did not locate the hand on the right site for chest compression. Placing her hands on the lower half of the sternum is more effective and increases the survival rate (Chi, Tsou, & Su, 2010) and (Zou et al, 2015). Defibrillation should be done as soon as possible to offer the best chances of survival for patients with VF.

The defibrillation trolley should come to the patient as soon as possible after beginning the compression (Heart attack; using chest compressions first just as successful as immediate defibrillation after cardiac arrest, 2010) and (Suzuki, 2010). The nurse who did the IV push did not let the other RN check the medication (dose, expiry date). It is very important to make sure two RN to check the medication in order to decrease the risk of mistakes (Boyd & Brady, 2012). The nurse who did the medication did not flush before giving the IV.

This helps reduce the risk of drug incompatibility. It is always recommended before and after with enough volume to that ensure that the dose administered enters the bloodstream and is not just sitting on the IV line (White et al, 2011) and (Wyant & Crickman, 2012). They were no swap between the nurses during the chest compression.

Rescuers should frequently alternate “ compression” duties, regardless of whether they feel fatigued, to ensure that fatigue does not interfere with the delivery of adequate chest compression. It also helps to prevent injury therefore, the swaps should intervene every 2-3 minutes when performing chest compression while another performs the CPR (Drager, 2012), ( Ogawa, 2011) and (Ehrlich, 2010). In addition, the nurse who did compression did not count compression loudly, which can make the person who given oxygen confused when to give breath. The compression at the chest should be done at a rate of 80-100 times a minute.

To get the correct counting rhythm one should count out loud as you do the compression for example by saying “ 1, 2… .5. Then rest on each compression number of the series (Ogawa, 2011) and (Ehrlich, 2010). Lastly, they were ineffective communication between the resuscitation team. When the doctor asked for oxygen saturation, no one responded to the doctor’ s question. Oxygen saturation should be checked before the doctor came (Grayson & Gandy, 2012) and (Passali, et al, 2011). In conclusion, the paper has reviewed the performance of a code blue event it has identified areas of strengths and weakness in accordance with ARC guidelines.

They were different areas of weakness. In performing the initial steps the nurse incorrectly accessed the responsiveness of the patient by shaking him and failed to press the code bluebell to call for help. Other noted mistakes in the video clip in performing the steps of the primary ABC survey. The nurse's airway management was poor. The first nurse failed to airway clear of oral contents or foreign material and backward head tilt and chin lift.

Similarly, the compressions were done incorrectly. The nurse who did compression should place her hands on the lower half of the sternum in such a position the compression is deemed ineffective, no count was done by the nurse and the was no pause when performing the compression. Other mistakes were delayed to apply defibrillation, poor communication, and one nurse did the compression the entire time rather than alternate with another nurse.

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