Date of Graduation

Winter 12-13-2019

Document Type

Project/Capstone

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

First Advisor

Dr. Susan Mortell, DNP, RN, CNL

Second Advisor

Dr. Elena Capella, Ed.D., MSN/MPA, RN, CNL, CPHQ, LNCC

Third Advisor

Robin Jackson, MSN, RN, CNL

Abstract

Preparing Healthcare Staff for Cardiac Arrest Codes in the Outpatient Clinical Setting: Code Drill Training Improves Patient Outcomes

The acuity of care provided in outpatient clinical settings across the United States continues to rise. It is estimated that more than 350,000 cardiac arrests occur outside of a hospital each year (AHA, 2019). For the purpose of this clinical nurse leader (CNL)-lead quality improvement project, the relevant focus is directed towards improving the knowledge, physical skills and perceptions of healthcare staff within an urgent care center (UCC) regarding the application of advanced rescue skills. It is important to note that the estimated 8,000 UCC’s nationwide often bridge the gap between the shortage of primary care providers (PCP’s) while simultaneously offering afterhours urgent/emergent care services (Stoimenoff & Newman, 2017). Many economic and demographic factors affect the diversity of the patient population seen at a UCC for primary care or non-life-threatening conditions and acute injury related treatments. Sudden cardiac arrest however, knows no boundary and requires UCC staff to be proficient in advanced rescue measures that rapidly stabilize patients which increase survival rates until they can be transported emergently to a hospital. Rogers and Rund further define proficiency skills as cross-training, knowledge of cardiac rhythm strips, pacing/cardioverting and defibrillating, intravenous/intraosseous access, and appropriate medication administration such as vasopressors and antiarrhythmics for all UCC staff based on scope of practice and training (2019).

The use of mock code (in situ) training, or “Code Drill” simulation, evaluates the strengths and weaknesses of the facility staff when dealing with emergent healthcare crisis such as a cardiac arrest or other cardiovascular events. Utilizing the TeamSTEPPS [see appendix A, Figures 1 & 2] approach during Code Drill simulation we will integrate and involve all staff members to advocate for the patient by implementing advanced rescue measures. These measures build greater situational team awareness, enhanced interdisciplinary communication, leadership and mutual support which work to alleviate fears, uncertainties and role confusion during a code. When these issues are addressed, the functionality of the team increases and patient outcomes improve.

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