Abstract P67: Institutional Multi-disciplinary Efforts to Improve Resuscitation Processes Have Saved Lives
Objective: Review of code team resuscitations in our 280 inpatient bed medical facility during a six month period in 2006 revealed incomplete capture of events, with 28% not reviewable due to inadequate documentation and 18% of reviewable events failing to meet NRCPR standards (SOC). These alarming statistics prompted a top to bottom analysis of resuscitation processes by a multidisciplinary team resulting in the recognition of three major vulnerabilities: antiquated paging hardware with insufficient alert processes; training and performance deficits among all levels of caregivers; and inadequate tracking, review, and feedback processes.
Methods: We concentrated on four initiatives:
Revamping the code activation process.
Daily tracking and review of code blue events with timely feedback.
A shift in training emphasis from ACLS providers to bedside BLS.
Sustainment training for all caregivers.
Results: All paging hardware was modernized, incoming calls recorded, backup pagers and defibrillators acquired, and team member response to daily system checks were monitored. Two fulltime personnel were hired. The result, a 3-fold increase in trackable events. A day of nursing orientation dedicated to CPR/code management principles was initiated. Our code blue nursing course refocused on equipment familiarity and a simulated documentation exercise was added yielding a 21% increase in reviewable records. All code blue team members received discipline specific instruction: Ex. Physician - leadership, Nursing -equipment, Chaplain - family liaison. The hospital implemented an aggressive BLS focused mock code program. For all code team activations, failure to meet SOC declined from 14.9% in 2007 to 7.9% in 2008. For all full code team activations, (ex. cardiopulmonary arrests), 77% met SOC in 2007 improving to 91% in 2008. Survival from an event precipitating a full code team activation was 82.2% for events that met SOC vs. only 62.1% for those that did not (0.02).
Conclusions: Our multifaceted initiatives have had a positive impact on our institutions resuscitation process (better capture, documentation, and performance). We estimate the improvements to date have saved several lives annually.