March 11, 2020

The NICU Interdisciplinary Mock Code Work Group knows every second counts in a code response to save critically ill patients’ lives.

The work group, which calls a mock code twice a month to give team members as much practice as possible, has managed to cut the response time to a code in half, from about 143 seconds to 77 seconds.

Elevate Team Award winners pose for a photo Wednesday, January 29, 2019 in the NICU at Vanderbilt University Medical Center in Nashville, Tennessee.

Photo by Erin O. Smith

Anytime a code is called in an intensive care unit, providers rush to the location to begin immediate resuscitative efforts. The team acts quickly and efficiently with each person knowing exactly what their role is. Seconds can make a difference in a critically ill patient’s life.

Three years ago, the Neonatal Intensive Care Unit Pediatric Assessment Response Team (PART) was formed at Monroe Carell Jr. Children’s Hospital’s Neonatal Intensive Care Unit to improve resuscitation skills and comfort level for NICU nurses.

From PART, the NICU Interdisciplinary Mock Code Work Group was formed. The work group received the Elevate Team Award at the Feb. 19 Leadership Assembly, an award that recognizes efforts by two or more people to improve a process, solve a problem or advance organizational culture at Vanderbilt University Medical Center.

The work group, which calls a mock code twice a month to give team members as much practice as possible, has managed to cut the response time to a code nearly in half over the past three years — from an average of 143 seconds to 77 seconds.

“This is no small feat in an intensive care unit spanning 10 patient care pods with health care team members responding from different areas,” the nomination read.

Mock codes are a learning opportunity to make sure that staff are extremely clear about their role so that there is less error. Prior to 2017, the codes were performed frequently, but not routinely. The Mock Code Work Group increased mock code opportunities to 24 a year (12 for day shift and 12 for night shift), tailoring scenarios to bedside situations (versus post-delivery codes that occur in the delivery room).

The mock codes have increased comfort level, the nomination read. “They believe that an effective code team is one that saves lives quickly, efficiently and safely. For a code team to achieve this, they must be organized, proficient with knowledge and skills and effective communicators,” it read.

The work group meets the first Monday of the month to discuss the mock codes and to identify barriers and areas which can be improved in the unit, which has about 100 babies in its care most of the time.

Jordan Bennett, BSN, RN, clinical staff leader in the NICU, said regular mock codes enable the unit to implement interventions that become part of the routine in how codes are run in the NICU.

“A code is always going to be chaos because it’s unplanned and you can’t predict when or what is going to happen,” she said. “Our goal is to make it a little more organized chaos.”

Before the team was formed, too many people responded to codes in the NICU, leading to confusion about who was leading the code and who filled what role. The team created designated responders to all codes.

“This eliminated a lot of chaos. It got the right people to the code,” said Caitlin Pugh, MSN, RNC-NIC, the group’s Quality and Safety Advisor. “It allowed people to fall into their roles and begin resuscitation in a less chaotic matter. So along with improving time, we improved communication and decreased the risk of an error occurring due to the chaos.”

Each code is responded to by a team of physicians, nurse practitioners, nurses, physicians’ assistants, respiratory therapists and pharmacists. Staff are assigned roles each shift. They wear color-coded stickers on their badges representing the team they are on and the role they fill on the team.

“We want to make sure everybody knows their role so we can identify during the code that they need to be there,” Bennett said. “If they don’t have a role, they don’t need to be in the room. We need space, quiet and room to work.”

Pugh said mock codes have traditionally been considered “extra” and something that staff felt they didn’t have time to do.

“This team, armed with data, showed that mock codes are an opportunity to do better. Each member reported back to their teams what we were learning through our trials and showed through practice that we could get to a patient faster, be more organized and communicate better.”

Pugh said being recognized with the award means a lot to the team.

“It shows that what we have done matters. We knew it mattered for the patients, but this is also a platform for us to share what we have done with other areas of the hospital. Hopefully, we can share our success, spread the knowledge and help more patients.”

Bennett agrees. “This group is highly motivated and that’s why we’ve gotten the results we have. We have a very passionate group and it’s wonderful for us to be recognized for the hard work we’ve put in. It’s been incredibly motivating.”

If you are a VUMC employee, you can nominate a colleague for an Elevate Credo Award, Five Pillar Leader Award, or Team Award. Visit the Elevate website to fill out a nomination form. Employees demonstrate credo behaviors when: they make those they serve the highest priority; respect privacy and confidentiality; communicate effectively; conduct themselves professionally; have a sense of ownership; and are committed to their colleagues. Elevate award nominations are accepted year-round. If a nomination is received after the cut off for an award selection period, the nomination will be considered for the next period. VUMC Voice will post stories on each of the award winners in the weeks following their announcement.