Mock Code Educational Planning Table

Title of Live Activity: Psych Mitigation Plan (Mock Code) Date of Activity:

Name and Credentials of person submitting this document Date:

Instructions: Check all that apply and fill in applicable blanks

Method of needs assessment: □Survey □Stakeholder Input [×] Change in Practice [×] Trended Data □Other_____

Description of current state: √Knowledge Deficit □Other_____________

Description of desired/achievable state: √Improve Nursing Practice □Other_____________

Gap to be addressed by this activity: [×] Knowledge [×] Skill [×] Practice □Other______________

Method of learner feedback: [×] Dialogue [×] Q&A [×] Role Play [×] Return Demo □Test □Other____________

Target Audience: All psychiatric nursing staff

The purpose of this activity is to ensure that the psychiatric nursing staff can recognize when to call Rapid Response vs
Code 99, activate the emergency response by calling out and dialing 1111 and initiates adult CPR and AED per AHA skills
checklist. Checks the emergency cart/equipment for efficiency and completeness, coordinates cart exchange with
Central Sterile Department (CSD), documents and debriefs each code activity on Cardiopulmonary Arrest Resuscitation
Flowsheet.

Time Contact Objectives (3-4 General Content (specific topics) Presenter Teaching Method
Frame Minutes “Take Aways” using
Bloom’ s Taxonomy):
At the end of this
program, the learner
will…..
Demonstrates proper Confirms presence of Dialogue, Role Play,
20 min procedure to check backboard, bag-mask device, Q&A, Return Demo
code cart/emergency oxygen face mask non-
equipment. rebreather, nasal cannula,
oxygen tank, AED, Zoll pads,
portable suction machine,
extension cord, sealed
intubation tray with date,
Identify location of 1st item to
expire, demonstrates operation
of oxygen tank, confirms code
ready status of defibrillator,
performs manual defibrillator.
Checks each drawer of cart for
supplies and location
Verbalizes AHA Reviews BLS protocol, Dialogue, Role Play,
40 min guidelines used to assessment, activation and Q&A, Return Demo
recognize and maintenance prior to code
intervene with steps in response team arrival
BLS algorithm
15 Demonstrates ability to Documents code activity on Dialogue, Role Play,
 document and debrief Cardiopulmonary Q&A, Return Demo
on code activity Arrest/Resuscitation Flowsheet
and scans into patient’s EMR.
Participates in code team
debriefing led by nursing
supervisor.
Success Completion: Attendance at entire event or session is required by Jamaica Hospital Medical Center Provider Unit.

All staff required to complete each skill on checklist.

Cart audit and audit tool must be completed.