Kelley Huseman MSN, RN-BC, spent 20 years as a critical care and intensive care nurse before joining a small community hospital in Pennsylvania, USA as a professional development specialist. One difference she quickly noted at the 130-bed Ephrata Community Hospital was the rare occurrence of a few code blues each month, far fewer than Huseman had seen during her nursing career. “I observed a few codes and realized they weren’t real smooth codes like I was used to,” Huseman said. “I thought if they could just practice more, they would get better at it.” In 2009, the hospital purchased iStan and The Nurse Residency Program and Huseman began to conduct unannounced code blue simulations. “I’d go in on weekends or at 2 a.m. in the morning and put him in a room, get him into a code blue scenario and put him in V-tach (ventricular tachycardia). I would call the emergency department and give them the heads up so they wouldn’t have to leave a busy ER to come to a drill,” says Huseman.
After witnessing improved performance within the ICU unit, Huseman decided to get all the departments involved in a code blue study. She published her results in the May/June Journal for Nurses in Staff Development in an article titled “Improving Code Blue Response Through the Use of Simulation.” During the study, Huseman measured response times for chest compressions, defibrillation and epinephrine administration before and after conducting mock code drills with iStan. The response times for start of chest compressions and epinephrine administration improved significantly. “I would call the code and start my stopwatch to see how long it would take people to show up. Getting there was not the issue. Getting people to actually start CPR was a big hurdle,” Huseman said. “I had to do a lot of education with the floor nurses that they need to start basic life support before the code team gets there.”
“When you have a code, someone has to establish themselves as a leader and nobody wanted to step forward and be in charge,” Huseman added. “They got much better at one person stepping up and saying ‘okay, they are in V-Tach, here is what we are going to do.’ ” Today, the hospital requires that every nurse participate in a code blue drill at least once a year, and Huseman generally conducts drills every month. “The staff really enjoyed working with iStan,” Huseman said. “But if I had seasoned nurses on a team that performed really poorly, I would let happen what would happen in a real-life situation. Having him die was really sobering for a lot of people.”