Paris Hotel and Casino  Las Vegas, Nevada

Improving Bedside CPR Skills and

Team Skills with In-Situ Simulations
Presented by:
Jennifer Sweeney, MSN, RN, CEN
Advanced Practice Program Coordinator
Center for Advanced Surgery & Simulation
Sarasota Memorial Health Care System
Presenter Disclosure
Information
Jennifer Sweeney, MSN, RN, CEN
Improving Bedside CPR Skills and Team Skills
with In-Situ Simulations.

No relevant financial relationships exist.

 Random In-situ Critical
Event Simulation
• Improving CPR skills and teamwork for
providers at the hospital patient’s bedside.
• This presentation will demonstrate the design
and implementation of the program
– Garnering stakeholder support.
– Tools to produce measurable outcomes.
– Results from 12 months of data collection.
Background

• SMHCS is a 806-bed regional medical center.

– 4,000 staff, 802 physicians
• Large simulation center with 8 High fidelity
simulators, 1 Program Coordinator, 0 Simulation
Technicians
• Florida “seasons” make in-lab training difficult to
schedule most of the year.
• Financial constraints necessitated driving the
simulation program out to the bedside.
Problem:

• Needs assessment revealed concern with direct care

providers’ comfort and confidence with recognizing
and responding to emergent patient care situations.
• Concern with cost involved with lengthy simulation
classes, loss of productive time, scheduling concerns,
etc.
• Fear in the first five minutes.
Solution:

• Short critical event scenarios are simulated in the

actual areas these events may take place.
• TeamSTEPPS principles integrated into scenario
planning and debriefing.
• Simulations last no longer than 20 minutes including
pre-briefing, conduction of the simulation, and
debriefing of all providers involved.
• Results shared with the unit educator and manager
for further review, in–depth debriefing, and ongoing
staff education.
TeamSTEPPS:

• Team Strategies and Tools to Enhance

Performance and Patient Safety
• FREE, Evidence-based teamwork system
aimed at optimizing patient outcomes by
improving communication and teamwork skills
among health care professionals.
• http://teamstepps.ahrq.gov/
Scenario Selection

• Interdisciplinary
• Short critical events
• IN-SITU
• Impromptu
• What scare you the most?
• Focus on patient safety and teamwork!
Garnering Support

- Keep it quick: in and out as fast as possible.

- Meaningful: set clear and realistic objectives.
- Interprofessional: look for your champions.
- Budget neutral: high fidelity, low fidelity, no fidelity.
- FOCUSED on PATIENT SAFETY.

Build it (Hype it) and they shall come!

Implementation
Conducted in-situ for no longer
than 20 minutes with any/all
health care team members
working at that time:
- 10 minutes for conduction of the
simulated event and 10 minutes for
debriefing of all providers involved.
Just do it! The program and
results sell themselves!
Video recorded for educational
review at a later time (staff
meeting, huddle, end of shift).
Debriefing focused on identification
and immediate correction of latent
safety threats and principles of
TeamSTEPPS.
Always have “crowd controllers” to
communicate with patients and
visitors during the exercise. Big
crowd pleaser!
 RISCE Simulation in OB ECC
Goal: Test new communication plan for rapidly
summoning help to new unit and overall
emergency preparedness of new unit.
MD
RN
RT
Time: 8 minute Scenario, 5 minute Debrief
Debriefing:
Latent Safety Threat Identified:
Operator paged out location
incorrectly causing delay in arrival of
NICU Team. Follow up meeting
scheduled that day to correct.
TeamSTEPPS: Excellent
demonstration of Mutual Support-
Concern voiced by physician to
increase speed of compressions.
Team did not respond. Physician
began counting cadence aloud.
Room for improvement noted in use
of call outs and check backs
between Respiratory Therapist and
Nurse.
Evaluation

Tool Selection:
- Quantitative Data for the number crunchers.
- Qualitative data for the emotional impact.
- Baseline data to compare to ongoing data.
- Look for tools that are already validated, reliable, have been
utilized in other programs, etc.
- TeamSTEPPS tools.
Outcomes

• Post-RISCE participant evaluation tool:

– Perceptions are evaluated per session and for
improvements over time.
• Review of the RISCE simulation video:
– TeamSTEPPS behaviors
• Scored as consistently applied ‘1’, inconsistently applied
‘0.5’, or absent ‘0’.
– BLS/ ACLS guidelines:
• Recommended practice is compared to actual performance.
– Video breakdown
  3/29/2012 6/10/2012 9/13/2012 12/16/2012 2/4/2013
Start time to recognition 0 10 10 15 10
Start time to call for help 0 30 10 15 25
Start time to start CPR 50 60 30 42 33
Start to arrival of AED 100 140 65 60 60
Start to use of AED 150 170 95 97 86
Start to Code Blue arrival 210 140 65 180 95
Compressor 1 time before switch 140 220 60 200 150
Compressor 2 time before switch          
Time off chest 1 20 40 15 18 20
Time off chest 2 10 30 12 30 10
Time off chest 3 35   20    
Time off chest 4 12        

Order should be Multiple calls made to

directed to a particular ensure code team and
person, then repeated NICU team were en Code Blue did not RN did not
back by that person. route, need better have badge visually clear
long delay from Poor closed loop closed loop access through team before
Safety threat 1 recognition to response communication communication new door delivering shock.

Infant resuscitation
area missing needle
Long breaks in chest decompression
Safety threat 2 long time off chest compressions supplies    
Safety threat 3          
Safety threat 4          
 Questions?

Jennifer Sweeney, MSN, RN, CEN

Sarasota Memorial Health Care System
Jennifer-sweeney@smh.com
941-917-1761
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