CREATE YOUR PEDIATRIC

MOCK CODE PROGRAM

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WELCOME

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ILLINOIS EMERGENCY

MEDICAL SERVICES FOR

CHILDREN (EMSC)

Illinois EMSC is a collaborative program within the Illinois Department of Public Health aimed at improving pediatric emergency care within our state.

Since 1994, The Illinois EMSC Advisory Board and several committees, organizations and individuals within EMS and pediatric communities have worked to enhance and integrate

Pediatric education

Practice standards

Injury prevention

Data initiatives

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This educational activity’s planners and the presenters have indicated they have no bias or conflict of interest.

4CONFLICT OF INTEREST

STATEMENT

ILLINOIS EMSC 2012

This program was developed through federal grant funding. All training materials are considered under public domain and can be utilized by others in the conduction of similar educational programs, provided there is acknowledgement of the source of these materials.

This slide set, and all related training materials, is in accordance with current practice at the time that this program was developed.

Suggested Citation: Create Your Pediatric Mock Code Program, Illinois Emergency Medical Services for Children, March 2012.

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AGENDA

1. Provide the background and history that led to this program offering

2. Develop strategies to respond to implementation barriers

3. Review the steps to pediatric mock code program creation

4. Incorporate facilitating and debriefing into pediatric mock codes (Exercise using three videotaped scenarios)

5. Maintain the gain

6. Wrap-up/Evaluation

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“Chance favors the

prepared mind.”

Louis Pasteur

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OBJECTIVES

Develop strategies to respond to implementation barriers

Review the steps to pediatric mock code program creation

Incorporate facilitating and debriefing into pediatric mock codes

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DEVELOP STRATEGIES TO RESPOND

TO IMPLEMENTATION BARRIERS

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DEVELOP STRATEGIES TO RESPOND

TO IMPLEMENTATION BARRIERS10

Time

Cost

Unclear how to set up the program

No one to coordinate the

programLack of

Interest

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11DEVELOP STRATEGIES TO RESPOND

TO IMPLEMENTATION BARRIERS

ILLINOIS EMSC 2012

Time

Cost

Unclear how to set up the program

No one to coordinate the

programLack of

Interest

12DEVELOP STRATEGIES TO RESPOND

TO IMPLEMENTATION BARRIERS

ILLINOIS EMSC 2012

Time

Cost

Unclear how to set up the program

No one to coordinate the

programLack of

Interest

13DEVELOP STRATEGIES TO RESPOND

TO IMPLEMENTATION BARRIERS

ILLINOIS EMSC 2012

Time

Cost

Unclear how to set up the program

No one to coordinate the

programLack of

Interest

14DEVELOP STRATEGIES TO RESPOND

TO IMPLEMENTATION BARRIERS

ILLINOIS EMSC 2012

Time

Cost

Unclear how to set up the program

No one to coordinate the

programLack of

Interest

15DEVELOP STRATEGIES TO RESPOND

TO IMPLEMENTATION BARRIERS

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Time

Cost

Unclear how to set up the program

No one to coordinate the

programLack of

Interest

REVIEW THE STEPS TO PEDIATRIC

MOCK CODE PROGRAM CREATION

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PEDIATRIC MOCK CODE PROGRAM VS.

PERFORMING A SINGLE MOCK CODE

Program

Needs assessment information is applicable to future events

Standard format builds predictability

Decrease staff fears

Practice over time builds competence and knowledge retention

Single mock code

Same amount of pre-code preparation needed

Effect of a one-time code is inadequate for knowledge retention

No opportunity to trend progress over time

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STEPS TO CREATE A PEDIATRIC MOCK

CODE PROGRAM

1 • Solicit management support

2 • Recruit team members

3 • Conduct a needs assessment

4 • Create scenario elements

5 • Complete logistical planning

6 • Conduct an initial pilot mock code

7 • Hold the pediatric mock code

8 • Analyze data and report program results

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STEP 1: SOLICIT MANAGEMENT

SUPPORT

Management Actions:

Support offering pediatric mock codes.

Allow a needs assessment.

Encourage other staff to participate.

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NEXT STEPS

Hold Mock Code

Step 2: Recruit team

members

Step 3: Conduct a

needs assessment

Step 4: Create the

forms Step 5: Complete the

logistical planning

Step 6: Conduct an initial pilot mock code

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STEP 2: RECRUIT TEAM MEMBERS

TEAM COMPOSITION AND CHARACTERISTICS21

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STEP 2: RECRUIT TEAM MEMBERS

D ISCUSS TIME COMMITMENT OPTIONS

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STEP 3: CONDUCT A NEEDS

ASSESSMENT23

Survey elements

Staff experience with children

Staff experience with pediatric

codes

Pediatric emergency topics

for practice

Preferred day and time for mock codes

Staff fear and level of

confidence with pediatric codes

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STEP 4: CREATE SCENARIO ELEMENTS

SCENARIO CREATION

Design based on staff needs assessment and institutional preferences

Create no more than 2-3 goals and objectives for each scenario

Keep in mind the skill level and experience of the learner

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Possible challenges:

Inexperience with defibrillator

Patient presents with an unstable airway

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STEP 4: CREATE SCENARIO ELEMENTS

SAMPLE CHALLENGES

Inexperience with defibrillator

?

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STEP 4: CREATE SCENARIO ELEMENTS

SAMPLE CHALLENGE

Inexperience with defibrillator

Safely utilize defibrillator

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STEP 4: CREATE SCENARIO ELEMENTS

CORRESPONDING OBJECTIVE

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STEP 4: CREATE SCENARIO ELEMENTS

SAMPLE CHALLENGE

Patient presents with an unstable airway

?

Patient presents with an unstable airway

Select correct size airway devices

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STEP 4: CREATE SCENARIO ELEMENTS

CORRESPONDING OBJECTIVE

Decide on a mock code recording tool

Current unit code review form

Template from Pediatric Mock Code toolkit

In-house version

Videotaping

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STEP 4: CREATE SCENARIO ELEMENTS

OBSERVER FORM

STEP 5: COMPLETE LOGISTICAL

PLANNING

LOGISTICS CHECKLIST:

Schedule mock code

Arrange for a facilitator and an observer (if needed)

Reserve space

Determine equipment needed

Check equipment location

Confirm replacement process

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Photo is property of Illinois EMSC

STEP 5: COMPLETE LOGISTICAL

PLANNING

LOGISTICS CHECKLIST

(continued):

Simulated patient choices

Videotaping

Repetitive practice

Evaluation forms

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Photo is property of Illinois EMSC

STEP 6: CONDUCT AN INITIAL PILOT

MOCK CODE33

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STEP 7: HOLD THE PEDIATRIC MOCK

CODE34

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STEP 8: ANALYZE THE DATA AND

REPORT PROGRAM RESULTS

REPORT ELEMENTS:

Facilitator feedback

Lessons learned

Suggestions

Track progress from baseline

Celebrate improvements

Assure safety of the data

Provide confidentiality

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STEPS TO CREATE A PEDIATRIC

MOCK CODE PROGRAM

1 • Solicit management support

2 • Recruit team members

3 • Conduct a needs assessment

4 • Create scenario elements

5 • Complete logistical planning

6 • Conduct an initial pilot mock code

7 • Hold the pediatric mock code

8 • Analyze the data and report program results

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Break time

10 minutes

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INCORPORATING FACILITATING AND

DEBRIEFING INTO PEDIATRIC MOCK

CODES

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WHY DEBRIEF?

To promote:

reflection

discussion

learning

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FACILITATORS CREATE A SAFE

LEARNING ENVIRONMENT

Emphasize mutual respect

Encourage team spirit and open expression by reaffirming common goals

Seal the environment =“What happens here stays here!”

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FACILITATOR MESSAGES TO MOCK

CODE PARTICIPANTS

ParticipantsWelcoming

Respectful

Teamwork Calm

Encouraging

Approachable

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FACILITATOR ACTIONS

Before the Scenario

Pre-brief elements

Environment and equipment

Introduce the scenario

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(Training guide: Using simulation in TeamSTEPPS Training, n.d.)ILLINOIS EMSC 2012

FACILITATOR ACTIONS (CONTINUED)

During the scenario

Provide information keeping in mind the scenario goals and objectives

Take notes on how it unfolds

Identify performance gaps

Identify debriefing points

What went well

What could be different, missing, awkward, etc.

After the scenario

Debrief the group

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(Training guide: Using simulation in TeamSTEPPS Training, n.d.)ILLINOIS EMSC 2012

DEBRIEF

Set the stage

Arrange to encourage discussion

Reemphasize safety

Describe the expectations for debriefing

State your objectives

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DEBRIEFING DO’S

Do..

Acknowledge and ask

Build, beliefs and barriers

Correct and collaborate

Demonstrate objective

observances

Emphasize and explore

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(Diane, Tsang & van Shaik, 2011)

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DEBRIEFING DO’S

Do..

Acknowledge and ask

Build, beliefs and barriers

Correct and collaborate

Demonstrate objective

observances

Emphasize and explore

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(Diane, Tsang & van Shaik, 2011)

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DEBRIEFING DO’S

Do..

Acknowledge and ask

Build, beliefs and barriers

Correct and collaborate

Demonstrate objective

observances

Emphasize and explore

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(Diane, Tsang & van Shaik, 2011)

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DEBRIEFING DO’S

Do..

Acknowledge and ask

Build, beliefs and barriers

Correct and collaborate

Demonstrate objective

observances

Emphasize and explore

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(Diane, Tsang & van Shaik, 2011)

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DEBRIEFING DO’S

Do..

Acknowledge and ask

Build, beliefs and barriers

Correct and collaborate

Demonstrate objective

observances

Emphasize and explore

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(Diane, Tsang & van Shaik, 2011)

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DEBRIEFING DON’TS

Accuse

Blame

Criticize

Sugarcoat

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3 PHASES OF

DEBRIEFING

Description Phase

Analysis Phase

Application/Generalization Phase

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(Training guide: Using simulation in TeamSTEPPS Training, n.d.)

3 PHASES OF DEBRIEFING:DESCRIPTION PHASE

Start by asking them to describe what emotions they are feeling

Recap the scenario

Have one person do a brief one to two sentence summary and others can add or subtract

Team members share their perspectives on what happened so everyone is on the ‘same page’

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3 PHASES OF DEBRIEFING:ANALYSIS PHASE

What would you do differently next time?

Yourself With others

What didn’t go well?

Yourself Team behavior

What went well?

Yourself Saw in others

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3 PHASES OF DEBRIEFING:APPLICATION/GENERALIZATION PHASE

Team members describe lessons learned

Changes in practice

Changes in policy

Changes in procedures

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IN SUMMARY…

Debrief to promote reflection, discussion, and learning

Create a safe environment

Incorporate “Do’s” when facilitating a debriefing and avoid debriefing “Don’ts”

Use the 3 phases of debriefing as guidance to allow conversation to flow

Refer back to your scenario goal, challenges and objectives to help focus the debriefing session

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DISCLAIMER

The contents of the following video are fictionalized. All medical personnel appearing in the scenarios are acting out assigned roles. Any resemblance to real events and people, living or deceased, is entirely coincidental.

The following video was filmed in a high fidelity simulation setting. It is important to understand that this level of technology is not necessary in order to perform an effective pediatric mock code.

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VIDEO FACILITATING AND

DEBRIEFING

Case #1

This is an example of a scenario and debriefing from A to Z

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Click Here

Break time

10 minutes

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Case #2

INCORPORATING FACILITATING

AND DEBRIEFING59

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Click Here

INCORPORATING FACILITATING

AND DEBRIEFING60

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Case #3

Click Here

GREAT JOB!61

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MAINTAIN THE GAIN

Complete pre-code needs assessment,

logistics, scenario and evaluation creation

Hold the pediatric mock code

Evaluate feedback from participants and

program members

Analyze feedback and report

suggestions to staff and

management

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RESOURCES

Resources available to you and your program

Mock code video scenarios

Pediatric Mock Code Toolkit

Train-the-Trainer PowerPoint Presentation

All resources are available online at www.luriechildrens.org/emsc

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REFERENCES

1. Topjian AA, Berg RA, Nadkarni VM. Pediatric cardiopulmonary resuscitation: Advances in science, techniques, and outcomes. Pediatrics. 2008 Nov;122(5):1086-98.

2. Andreatta P, Saxton E, Thompson M, Annich G. Simulation-based mock codes significantly correlate with improved pediatric patient cardiopulmonary arrest survival rates. PEDIATR CRIT CARE MED. 2011;12(1):33-8.

3. von Arx D, Pretzlaff R. Improved nurse readiness through pediatric mock code training. J Pediatr Nurs. 2010 10;25(5):438-40.

4. Hunt EA, Hohenhaus SM, Luo X, Frush KS. Simulation of pediatric trauma stabilization in 35 North Carolina emergency departments: Identification of targets for performance improvement. Pediatrics. 2006 03;117(3):641-8.

5. Mancini ME, Soar J, Bhanji F, Billi JE, Dennett J, Finn J, et al. Part 12: Education, implementation, and teams: 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2010 Oct 19;122(16 Suppl 2):S539-81.

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REFERENCES

6. Mikrogianakis A, Osmond MH, Nuth JE, Shephard A, Gaboury I, Jabbour M. Evaluation of a multidisciplinary pediatric mock trauma code educational initiative: A pilot study. J Trauma. 2008 Mar;64(3):761-7.

7. van Schaik SM, Plant J, Diane S, Tsang L, O'Sullivan P. Interprofessional team training in pediatric resuscitation: A low-cost, in situ simulation program that enhances self-efficacy among participants. Clin Pediatr (Phila). 2011 Sep;50(9):807-15.

8. Mann K, van der Vleuten C, Eva K, Armson H, Chesluk B, Dornan T, et al. Tensions in informed self-assessment: How the desire for feedback and reticence to collect and use it can conflict. Acad Med. 2011 Sep;86(9):1120-7.

9. Auerbach M, Kessler D, Foltin JC. Repetitive pediatric simulation resuscitation training. Pediatr Emerg . 2011 Jan; 27(1): 29-31.

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REFERENCES

10. Fanning RM, Gaba DM. The role of debriefing in simulation-based learning. Simul Healthcare. 2007 Summer;2(2):115-25.

11. Beaubien JM, Baker DP. The use of simulation for training teamwork skills in health care: How low can you go? Qual Saf Health Care. 2004 Oct;13 Suppl 1:i51-6.

12. Training Guide: Using Simulation in TeamSTEPPS Training retrieved 1.2012 from Link: http://www.ahrq.gov/teamsteppstools/simulation/index.html

13. Diane S., Tsang L, van Shaik, S.UCSF Children’s Hospital Mock Code Training PowerPoint 2011 by the Regents of the University of California. Used with permission.

14. Rudolph JW, Simon R, Rivard P, Dufresne RL, Raemer DB Debriefing with Good Judgment: Combining Rigorous Feedback with Genuine Inquiry. Anesthesiology Clin 2007 June; 25(2):361–376.

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THANKS!

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