AGH’s “Five Alive” Mock Code Simulation Improves Crisis Response

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Allegheny Health Network, Nursing
AGH nurses Michele Prior, Diane Blazier and  Linda Delac

Kathy Delac, MSN, RN, CNS and Diane Blazier, MSN, RN, CES, nurse educators at Allegheny General Hospital (AGH), a part of Allegheny Health Network (AHN), know that what happens in the first five minutes after cardiac or pulmonary arrest is crucial to the patient’s outcome.

When they observed nurses responding with anxiety and confusion that delayed cardiopulmonary resuscitation, they created “Five Alive” – a highly effective performance improvement education program that uses manikins as simulated patients to improve nurse performance in those crucial first five minutes of a patient’s actual or impending arrest – before the Code Blue or rapid response team arrives. 

They based their program on three findings: A nurse’s number one fear is not knowing what to do if a patient arrests. A survey of AGH nurses found they wanted to participate in mock codes. Mock code training using simulation and video debriefing is an effective tool in performance improvement. 

To design and deliver the education, they partnered with the STAR (Simulation, Teaching and Academic Research) Center, now part of AHN’s Interprofessional Education and Collaborative Practice (IPEC) Department, headed by AHN Vice President Donamarie N-Wilfong, DNP, RN.

Michele Prior, MSN, RN, Advanced Practice Nurse at AGH, developed a similar Pediatric Code Blue simulation program for pediatric care givers.

Both programs’ objectives are for participants to quickly identify a patient’s declining health status, initiate appropriate first-responder interventions, effectively and competently use appropriate emergency equipment, and express improved confidence in responding to patient health crises.

The educators regularly hold one-hour simulated crisis situations with video debriefing on adult telemetry and medical-surgical units or the Pediatric Unit at AGH. Responders find a manikin (adult or child/infant) in a patient bed/crib in a patient room, in actual or threatened cardiac/pulmonary arrest. Their response, using the unit’s resuscitation equipment, is videotaped. 

On adult units, a second scenario is presented and the videotapes and differences in times to CPR and defibrillation between the first and second scenarios are analyzed.

For Pediatric Code Blue simulations, a pediatrician participates in the crisis scenario, simulating a condition such as unstable supraventricular tachycardia. Response videotapes are reviewed during the debriefing.

Participants also complete pre- and post-code surveys about their confidence in performing response tasks.

For the first 103 nurses who participated in adult Five Alive programs, Delac and Blazier saw an average of:

  • 65% improvement in time to CPR from the first to the second scenario
  • 67% improvement in time to defibrillation from the first to the second scenario
  • 20.4% increase in confidence recognizing declining patient health, initiating appropriate first-responder interventions, and providing appropriate hand-off report to the rapid response or code team

Pediatric Code Blue simulation training has effectively improved participants’ level of confidence in initiating appropriate first-responder interventions and in using emergency equipment for life support until the rapid response or Pediatric Code Blue team arrives.

The nurses have implemented their successful education programs at other AHN facilities and presented their results at both regional and national conferences.