Reducing Out-of-Unit Codes by Implementing an Interprofessional Skills Day Utilizing Simulation

Purpose:
In January 2014,the Education Team identified a rise in Out of Unit Codes (OOUC. Knowing that ultimately the prevention of progression from MRTs to OOUC relied largely on a high-functioning MRT team, an educational opportunity was created utilizing simulation for the ICU and Respiratory staff.

Relevance/Significance:
Positive outcomes during a Code Blue are often largely dependent on the synergy or high quality interrelated performance of the team during the code. As many disciplines respond to a Code Blue, it is essential that interprofessional collaboration be nurtured. Simulation provides an environment in which these disciplines can “practice” the skills of a code situation together and receive timely feedback on performance of key skills that will be essential when applied to real patients.

Strategy and Implementation:
In February 2014,after identifying that the number of Out of Unit Codes were increasing,a Code Blue class was designed that was intended to be incorporated into annual Skills Day,which every ICU registered nurse (RNs) and respiratory therapists (RTs)is required to attend.This provided an opportunity for those RNs and RTs to respond to MRTs in order to develop lifelong skills that would prevent MRTs from progressing to OOUCs.A high-fidelity mannequin and simulation technology allow Educators to create real-life scenarios, while providing a safe place for RNs and RTs to practice care.Both disciplines were asked to perform various tasks,at which point the “patient” began to decompensate.A MRT was called,which had the potential to evolve into a Code Blue.ICU clinical nurses and respiratory therapists would work together towards the prevention of a Code Blue, or in the case of a Code Blue, resuscitation of the patient.After the simulation scenario,the Educators facilitated a debrief.  

Evaluation:
Ongoing monitoring of the monthly rate of MRTs that progressed to OOUCs. The redesign of Skills Day for ICU nurses and Respiratory Therapists was overwhelmingly positive. Incorporating an interprofessional Code Blue simulation has reduced the number of MRTs that progressed to OOUCs in 2014 from 6.7% in March 2014 (time of intervention) to 2.4% or less from April to December 2014.

Implications for Practice:
The ability to practice collaboration and communication with another discipline was invaluable.Incorporating an interprofessional Code Blue simulation has reduced the number of MRTs that progressed to OOUCs.This intervention reinforced the development of team concepts.