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Mock Codes in a Radiology Department for Systems Improvement and Staff Competency

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Abstract

This article explores the use of mock codes in a radiology area in a 550-bed teaching hospital to see if they identify inadequacies in systems, standards of care, and teamwork that could be remediated in the interest of optimal patient care. Mock codes were run in different units in the radiology department, two newly opened. A total of 38 multidisciplinary responders participated in the mock codes, some from radiology and others from hospital code teams. Responder arrivals and actions were timed and evaluated for teamwork and standards of care. Systems issues were also identified. Debriefing occurred after each session, and participants were asked to complete a postsession evaluation. Significant systems, standards of care, and teamwork shortfalls were identified related to code paging, wayfinding, access to emergency equipment, team leadership, and cardiopulmonary resuscitation. Participants rated the event as a valuable use of their time. Remedial discussions took place during debriefings, and corrective actions began after the sessions. The mock codes were useful exercises that identified systems issues and allowed staff to reflect on their teamwork and resuscitation skills to determine how they could respond more effectively during future events. Remediation included improvements in paging and wayfinding and the implementation of team training and emergency equipment reviews. Continued evaluation will take place using mock codes.

Section snippets

Methods

A series of identical mock codes was started in 2013 to identify systems issues and staff competency in responding to code events in the ground floor radiology department of the 550-bed Level 1 academic medical center. Each mock was unannounced and took place in a different part of the department. A Laerdal Resusci Anne® QCPR® manikin was used with the SimPad® SkillReporter™. This manikin provided objective CPR data that could be shared with staff during the debriefing. The simulated patient

Results

Table 1 shows the systems issues that were identified during the radiology mock codes centered around difficulties calling codes, operator paging issues, unclear room labeling, and wayfinding. For instance, during one of the mock codes, a staff member called the regular hospital operator number rather than the specially designated emergency number to call the code. Calling the regular number could result in being placed on hold if all the operators are busy. The emergency number is picked up

Remediation

In 2015, the radiology department completed a 5-year renovation project impacting six different modalities. The maze of hallways that previously existed in the department has been replaced with one long east-west hallway and four north and south branches. The radiology department is working with the facilities department to install blue directional ceiling lights to assist with wayfinding to critical events. The objective was to assist code team members when entering the radiology department

Conclusion

Limitations of this effort include the low number of mock codes run, although nearly the same deficiencies were noted at all the simulations. Another limitation is the relatively few radiology staff members and code team responders who participated compared with the total rosters of each of those groups. In future, more consistent mock codes and new mandatory participation requirements for all staff in FFMs and other resuscitation and team training simulations will continue to address this

Sally Rudy, MSN, RN-BC, CHSE, Simulation Educator, Penn State Hershey Clinical Simulation Center, Hershey, PA

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Sally Rudy, MSN, RN-BC, CHSE, Simulation Educator, Penn State Hershey Clinical Simulation Center, Hershey, PA

Vicki Rooney, RT(R), Radiology Assistant Manager, Penn State Hershey Medical Center, Hershey, PA

Eileen Westley-Hetrick, MSN, RN, Clinical Nurse Educator, Department of Nursing Education and Professional Development, Penn State Hershey Medical Center, Hershey, PA

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