RN Unit Supervisor Alexandria, Virginia, United States
Disclosure(s):
Lauren Hooper, RN, BSN, CCRN: No financial relationships to disclose
Background: The Cardiac Intensive Care Unit (CICU) at a large Level 1 trauma center in Northern Virginia saw substantial change in the experience level of the nurses in 2024. Due to a nursing turnover, MOCK codes were conducted in unit to increase confidence and facilitate interdisciplinary teamwork.
Methods: The unit-based Professional Development Committee, in collaboration with the Medical Director, saw an opportunity to conduct interdisciplinary in-situ mock codes to improve confidence and performance in resuscitation scenarios. Unannounced mock codes were conducted monthly in-unit for both day and night clinicians. Scenarios progressed in complexity each quarter starting with simpler to more complex situations. Phase one focused on basic ACLS algorithms such as asystole, unstable bradycardia and ventricular tachycardia without a pulse. The second phase integrated vasopressors, sedation, antiarrhythmics, and rapid sequence intubation. Phase three centered on advanced heart failure, cardiogenic shock, and Swan-Ganz catheter management. The final phase incorporated complications related to mechanical circulatory support devices such as Intra-aortic Balloon Pump and Impella. A twenty minute debrief was conducted after each mock scenario to facilitate conversations and education opportunities. Evaluation of the intervention was completed using a six-question pre- and post-survey with Likert scale questions and free response.
Outcome: Over the past year, 120 nurses have attended the mock codes. Of the 33 nurses that responded to the survey, 87% reported feeling more confident, a 13.5% increase from the pre- implementation survey. There was 33.4% increase in confidence with role delegation. Furthermore, the team reported a 17.7% increase in confidence with executing ACLS algorithms. The free response answers were resoundingly positive, with team members stating the mocks provided clarity, confidence, and improved communication.
Conclusion: The mocks have been instrumental in increasing our team's confidence in responding to codes in CICU. The mocks have improved team dynamics, streamlined team response, and facilitated interdisciplinary communication. In-situ mocks will continue throughout the upcoming year to continue building our team.
