Safety: Simulate Emergencies in Bedside Mock Drills

Patient Safety

By: Michael Kost

Published: 1/14/2020

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Let staff practice their response to urgent situations before they occur


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.

Simulation on a smaller scale
RED PLATE SPECIAL A red plate was installed above the emergency response button so staff could easily locate the button on the wall.   |  Michael Kost, DNP, CRNA, CHSE

What changes might you make in your facility if you ran a simulation with your staff in a patient care setting, be it pre-op, the OR or PACU? You might be amazed at the small and not-so-small opportunities for improvement you'll spot. You'll also be pleased at the heightened level of situational awareness and teamwork your staff will exhibit after participating in mock code emergency drills.

To test your systems as well as uncover trouble spots, you'll want to bring the simulation bedside. Running the mock drills in the actual patient care setting helps to achieve a high level of fidelity and realism. In situ simulation is also beneficial to evaluate staff responsiveness to high acuity, low-occurrence (HALO) events, such as cardiac arrest, a lost airway, malignant hyperthermia, local anesthesia toxicity and a surgical fire.

Simulation need not take much time or cost much money. Time for the actual simulation is generally limited to 5 to 10 minutes. You can mobilize your simulation efforts for as little as a $3,500 CPR training torso, a $100 handycam and a little effort developing an appropriate patient scenario for your setting.

CPR BOOST A step stool helps shorter rescuers deliver deeper chest compressions during cardiopulmonary resuscitation.   |  Michael Kost, DNP, CRNA, CHSE

To defer costs, you can partner with a few other surgical facilties in your community and rotate the equipment every few weeks.

Even though it's a simulation, staff anxiety will likely skyrocket because you're measuring your team's performance in a life-or-death situation. Stress that simulation is not a competition. All you want your staff to do is beat their performance in the next code drill. The idea is to grow and get better.

Time to debrief — and learn

Learning occurs in the debriefing phase soon after the simulation drills. In order to provide formative feedback and reinforce positive behaviors, assure participants before the debriefing that they are in a psychologically safe space. Start the debriefing session by stating: "What happened here, stays here — we are in a protected environment, not a competition. We believe everyone here is intelligent, professional and wants to improve their collective performance." OSM

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