Participating in In Situ Mock Codes Improves Confidence of the New Graduate RN

Abstract

Significance: In-hospital cardiac arrest (IHCA) is a substantial public health concern that is likely to leave a wake of devastation for families, healthcare workers and the rare 10-24% of survivors who experience it (Attin, Tucker & Carey, 2016; Field et al., 2010). Delays in providing CPR and advanced cardiac life support (ACLS) by nursing staff is one of several significant factors that negatively impacts the survival rate of IHCA (Bircher et al., 2019). Purpose: The purpose of this quality improvement project was to increase confidence in ACLS skills of the New Graduate Registered Nurse (New Grad) through the implementation of an in situ mock code program. Methods: A pretest/post-test survey design was used to determine the effectiveness of an in situ mock code program. An eight-item survey was used to evaluate confidence in ACLS skills amongst a New Grad cohort at Flagstaff Medical Center (FMC) before and after implementation of the program. Eight, 30-minute in situ mock codes were organized for New Grads to practice in artificial code blue scenarios in the safety and familiarity of their home units during working hours. Sample: A sample of sixteen New Grads from a twenty-one-member cohort at FMC, during the summer of 2019, were surveyed using a pretest evaluation. Sixteen of the twenty-one New Grads participated in an in situ mock code and completed post-test surveys. Results: This quality improvement project resulted in improved confidence of New Grads in delivery of rescue breathing, in administering medications and dosing knowledge, and in code team leadership. Confidence in delivering chest compressions, ability to assess for a pulse and breathing, identifying dysrhythmias, using a cardiac monitor/defibrillator, and recalling ACLS algorithms did not improve. Conclusion & Discussion: On completion of this project and research of supporting evidence for implementation of an in situ mock code program, the use of repeated mock code training may be an effective strategy in providing increased confidence in the New Grad. This quality improvement project demonstrated that confidence associated with providing ACLS skills for IHCA may not be improved by the use of a single in situ mock code. Thus, it is recommended that multiple in situ mock codes be provided for the New Graduate Registered Nurse as a frequent and ongoing tool. Additionally, the practice and use of the program would be recommended for use with all bedside nursing staff, regardless of education or career longevity.