Nurse-Led Strategies to Improve In-Hospital Code Blue Survival Rates

Abstracts from the Kaiser Permanente2018 National Quality Conference


Rebecca Campbell, RN, CCRN; Patrice Chatterton, RNC, CPHQ;
Christopher Cox, RN, CEN, CCRN; Anna Sandgren, RN

From Northwest

Background: Nationwide, there are more than 200,000 in-hospital cardiac arrests each year. Of these in-hospital cardiac arrests, only about 54% survive the actual code event, whereas far fewer, around 22%, survive to discharge. Rapid response team (RRT) nurses aimed to improve Code Blue response and actual code event survival by focusing on simulation education, cardiopulmonary resuscitation feedback tools, early team debriefing, and structured review of each code event to identify systems issues in a monthly Code Blue Workgroup.
Methods: In 2016, the Kaiser Sunnyside Medical Center (KSMC) Code Blue Workgroup committed to improving quality metrics that included the use of the Philips Q-CPR (Philips, Amsterdam, The Netherlands) feedback tool during code events, documenting end tidal capnography, early code team debrief, and a structured review of each code. Code Blue simulations were conducted with the KSMC Simulation Department and led by RRT nurses. The simulations were tailored for each hospital arena, focusing on code team member roles and competence using the Q-CPR tool. Each month, the Code Blue Workgroup members were assigned codes to review identifying potential contributing factors, systems issues, and adherence to quality metrics, which are presented for discussion.
Results: On the basis of the KSMC team efforts, survival of the code event increased by 18% during this time, or 63% in 2016 (n = 52) to 81% of patients in 2017 (n = 58). Performances measures were tracked on the basis of a percentage target. Q-CPR use during codes went from 61% in 2016 to 95% in 2017, with a target of 90% of code events that include chest compressions. Capnography documentation went from 36% in 2016 to 82% in 2017, with a target of 80% in code events that include pulselessness and intubation. Early debrief by the code team went from 82% in 2016 to 92% in 2017, with a target of 60% of codes. A structured code review by the Code Blue Workgroup remained at 100% of codes in both 2016 and 2017.
Discussion: The most important factors in the success of this work is a dedicated Code Blue team and Workgroup invested in the process and a robust action log based on team debrief concerns. The RRT team was present at each simulation and ensured consistent debriefing occurred. These debrief learnings were then brought to each Code Blue Workgroup meeting and entered in an action log. Concerns identified in codes that led to change included code compatible chairs in hemodialysis and a CareFusion Pyxis machine (Beckton, Dickinson, and Co; Franklin Lakes, NJ) located in the magnetic resonance imaging department. Given the success of this process, the goal is to replicate it with code events involving stroke or massive transfusion.

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