CREATE YOUR PEDIATRIC
MOCK CODE PROGRAM
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WELCOME
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ILLINOIS EMERGENCY
MEDICAL SERVICES FOR
CHILDREN (EMSC)
Illinois EMSC is a collaborative program within the Illinois Department of Public Health aimed at improving pediatric emergency care within our state.
Since 1994, The Illinois EMSC Advisory Board and several committees, organizations and individuals within EMS and pediatric communities have worked to enhance and integrate
Pediatric education
Practice standards
Injury prevention
Data initiatives
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This educational activity’s planners and the presenters have indicated they have no bias or conflict of interest.
4CONFLICT OF INTEREST
STATEMENT
ILLINOIS EMSC 2012
This program was developed through federal grant funding. All training materials are considered under public domain and can be utilized by others in the conduction of similar educational programs, provided there is acknowledgement of the source of these materials.
This slide set, and all related training materials, is in accordance with current practice at the time that this program was developed.
Suggested Citation: Create Your Pediatric Mock Code Program, Illinois Emergency Medical Services for Children, March 2012.
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AGENDA
1. Provide the background and history that led to this program offering
2. Develop strategies to respond to implementation barriers
3. Review the steps to pediatric mock code program creation
4. Incorporate facilitating and debriefing into pediatric mock codes (Exercise using three videotaped scenarios)
5. Maintain the gain
6. Wrap-up/Evaluation
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“Chance favors the
prepared mind.”
Louis Pasteur
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OBJECTIVES
Develop strategies to respond to implementation barriers
Review the steps to pediatric mock code program creation
Incorporate facilitating and debriefing into pediatric mock codes
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DEVELOP STRATEGIES TO RESPOND
TO IMPLEMENTATION BARRIERS
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DEVELOP STRATEGIES TO RESPOND
TO IMPLEMENTATION BARRIERS10
Time
Cost
Unclear how to set up the program
No one to coordinate the
programLack of
Interest
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11DEVELOP STRATEGIES TO RESPOND
TO IMPLEMENTATION BARRIERS
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Time
Cost
Unclear how to set up the program
No one to coordinate the
programLack of
Interest
12DEVELOP STRATEGIES TO RESPOND
TO IMPLEMENTATION BARRIERS
ILLINOIS EMSC 2012
Time
Cost
Unclear how to set up the program
No one to coordinate the
programLack of
Interest
13DEVELOP STRATEGIES TO RESPOND
TO IMPLEMENTATION BARRIERS
ILLINOIS EMSC 2012
Time
Cost
Unclear how to set up the program
No one to coordinate the
programLack of
Interest
14DEVELOP STRATEGIES TO RESPOND
TO IMPLEMENTATION BARRIERS
ILLINOIS EMSC 2012
Time
Cost
Unclear how to set up the program
No one to coordinate the
programLack of
Interest
15DEVELOP STRATEGIES TO RESPOND
TO IMPLEMENTATION BARRIERS
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Time
Cost
Unclear how to set up the program
No one to coordinate the
programLack of
Interest
REVIEW THE STEPS TO PEDIATRIC
MOCK CODE PROGRAM CREATION
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PEDIATRIC MOCK CODE PROGRAM VS.
PERFORMING A SINGLE MOCK CODE
Program
Needs assessment information is applicable to future events
Standard format builds predictability
Decrease staff fears
Practice over time builds competence and knowledge retention
Single mock code
Same amount of pre-code preparation needed
Effect of a one-time code is inadequate for knowledge retention
No opportunity to trend progress over time
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STEPS TO CREATE A PEDIATRIC MOCK
CODE PROGRAM
1 • Solicit management support
2 • Recruit team members
3 • Conduct a needs assessment
4 • Create scenario elements
5 • Complete logistical planning
6 • Conduct an initial pilot mock code
7 • Hold the pediatric mock code
8 • Analyze data and report program results
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STEP 1: SOLICIT MANAGEMENT
SUPPORT
Management Actions:
Support offering pediatric mock codes.
Allow a needs assessment.
Encourage other staff to participate.
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NEXT STEPS
Hold Mock Code
Step 2: Recruit team
members
Step 3: Conduct a
needs assessment
Step 4: Create the
forms Step 5: Complete the
logistical planning
Step 6: Conduct an initial pilot mock code
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STEP 2: RECRUIT TEAM MEMBERS
TEAM COMPOSITION AND CHARACTERISTICS21
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STEP 2: RECRUIT TEAM MEMBERS
D ISCUSS TIME COMMITMENT OPTIONS
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STEP 3: CONDUCT A NEEDS
ASSESSMENT23
Survey elements
Staff experience with children
Staff experience with pediatric
codes
Pediatric emergency topics
for practice
Preferred day and time for mock codes
Staff fear and level of
confidence with pediatric codes
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STEP 4: CREATE SCENARIO ELEMENTS
SCENARIO CREATION
Design based on staff needs assessment and institutional preferences
Create no more than 2-3 goals and objectives for each scenario
Keep in mind the skill level and experience of the learner
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Possible challenges:
Inexperience with defibrillator
Patient presents with an unstable airway
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STEP 4: CREATE SCENARIO ELEMENTS
SAMPLE CHALLENGES
Inexperience with defibrillator
?
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STEP 4: CREATE SCENARIO ELEMENTS
SAMPLE CHALLENGE
Inexperience with defibrillator
Safely utilize defibrillator
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STEP 4: CREATE SCENARIO ELEMENTS
CORRESPONDING OBJECTIVE
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STEP 4: CREATE SCENARIO ELEMENTS
SAMPLE CHALLENGE
Patient presents with an unstable airway
?
Patient presents with an unstable airway
Select correct size airway devices
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STEP 4: CREATE SCENARIO ELEMENTS
CORRESPONDING OBJECTIVE
Decide on a mock code recording tool
Current unit code review form
Template from Pediatric Mock Code toolkit
In-house version
Videotaping
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STEP 4: CREATE SCENARIO ELEMENTS
OBSERVER FORM
STEP 5: COMPLETE LOGISTICAL
PLANNING
LOGISTICS CHECKLIST:
Schedule mock code
Arrange for a facilitator and an observer (if needed)
Reserve space
Determine equipment needed
Check equipment location
Confirm replacement process
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Photo is property of Illinois EMSC
STEP 5: COMPLETE LOGISTICAL
PLANNING
LOGISTICS CHECKLIST
(continued):
Simulated patient choices
Videotaping
Repetitive practice
Evaluation forms
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Photo is property of Illinois EMSC
STEP 6: CONDUCT AN INITIAL PILOT
MOCK CODE33
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STEP 7: HOLD THE PEDIATRIC MOCK
CODE34
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STEP 8: ANALYZE THE DATA AND
REPORT PROGRAM RESULTS
REPORT ELEMENTS:
Facilitator feedback
Lessons learned
Suggestions
Track progress from baseline
Celebrate improvements
Assure safety of the data
Provide confidentiality
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STEPS TO CREATE A PEDIATRIC
MOCK CODE PROGRAM
1 • Solicit management support
2 • Recruit team members
3 • Conduct a needs assessment
4 • Create scenario elements
5 • Complete logistical planning
6 • Conduct an initial pilot mock code
7 • Hold the pediatric mock code
8 • Analyze the data and report program results
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Break time
10 minutes
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INCORPORATING FACILITATING AND
DEBRIEFING INTO PEDIATRIC MOCK
CODES
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WHY DEBRIEF?
To promote:
reflection
discussion
learning
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FACILITATORS CREATE A SAFE
LEARNING ENVIRONMENT
Emphasize mutual respect
Encourage team spirit and open expression by reaffirming common goals
Seal the environment =“What happens here stays here!”
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FACILITATOR MESSAGES TO MOCK
CODE PARTICIPANTS
ParticipantsWelcoming
Respectful
Teamwork Calm
Encouraging
Approachable
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FACILITATOR ACTIONS
Before the Scenario
Pre-brief elements
Environment and equipment
Introduce the scenario
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(Training guide: Using simulation in TeamSTEPPS Training, n.d.)ILLINOIS EMSC 2012
FACILITATOR ACTIONS (CONTINUED)
During the scenario
Provide information keeping in mind the scenario goals and objectives
Take notes on how it unfolds
Identify performance gaps
Identify debriefing points
What went well
What could be different, missing, awkward, etc.
After the scenario
Debrief the group
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(Training guide: Using simulation in TeamSTEPPS Training, n.d.)ILLINOIS EMSC 2012
DEBRIEF
Set the stage
Arrange to encourage discussion
Reemphasize safety
Describe the expectations for debriefing
State your objectives
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DEBRIEFING DO’S
Do..
Acknowledge and ask
Build, beliefs and barriers
Correct and collaborate
Demonstrate objective
observances
Emphasize and explore
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(Diane, Tsang & van Shaik, 2011)
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DEBRIEFING DO’S
Do..
Acknowledge and ask
Build, beliefs and barriers
Correct and collaborate
Demonstrate objective
observances
Emphasize and explore
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(Diane, Tsang & van Shaik, 2011)
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DEBRIEFING DO’S
Do..
Acknowledge and ask
Build, beliefs and barriers
Correct and collaborate
Demonstrate objective
observances
Emphasize and explore
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(Diane, Tsang & van Shaik, 2011)
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DEBRIEFING DO’S
Do..
Acknowledge and ask
Build, beliefs and barriers
Correct and collaborate
Demonstrate objective
observances
Emphasize and explore
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(Diane, Tsang & van Shaik, 2011)
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DEBRIEFING DO’S
Do..
Acknowledge and ask
Build, beliefs and barriers
Correct and collaborate
Demonstrate objective
observances
Emphasize and explore
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(Diane, Tsang & van Shaik, 2011)
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DEBRIEFING DON’TS
Accuse
Blame
Criticize
Sugarcoat
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3 PHASES OF
DEBRIEFING
Description Phase
Analysis Phase
Application/Generalization Phase
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(Training guide: Using simulation in TeamSTEPPS Training, n.d.)
3 PHASES OF DEBRIEFING:DESCRIPTION PHASE
Start by asking them to describe what emotions they are feeling
Recap the scenario
Have one person do a brief one to two sentence summary and others can add or subtract
Team members share their perspectives on what happened so everyone is on the ‘same page’
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3 PHASES OF DEBRIEFING:ANALYSIS PHASE
What would you do differently next time?
Yourself With others
What didn’t go well?
Yourself Team behavior
What went well?
Yourself Saw in others
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ILLINOIS EMSC 2012 (Training guide: Using simulation in TeamSTEPPS Training, n.d.)
3 PHASES OF DEBRIEFING:APPLICATION/GENERALIZATION PHASE
Team members describe lessons learned
Changes in practice
Changes in policy
Changes in procedures
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ILLINOIS EMSC 2012 (Training guide: Using simulation in TeamSTEPPS Training, n.d.)
IN SUMMARY…
Debrief to promote reflection, discussion, and learning
Create a safe environment
Incorporate “Do’s” when facilitating a debriefing and avoid debriefing “Don’ts”
Use the 3 phases of debriefing as guidance to allow conversation to flow
Refer back to your scenario goal, challenges and objectives to help focus the debriefing session
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DISCLAIMER
The contents of the following video are fictionalized. All medical personnel appearing in the scenarios are acting out assigned roles. Any resemblance to real events and people, living or deceased, is entirely coincidental.
The following video was filmed in a high fidelity simulation setting. It is important to understand that this level of technology is not necessary in order to perform an effective pediatric mock code.
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VIDEO FACILITATING AND
DEBRIEFING
Case #1
This is an example of a scenario and debriefing from A to Z
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Click Here
Break time
10 minutes
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Case #2
INCORPORATING FACILITATING
AND DEBRIEFING59
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Click Here
INCORPORATING FACILITATING
AND DEBRIEFING60
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Case #3
Click Here
GREAT JOB!61
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MAINTAIN THE GAIN
Complete pre-code needs assessment,
logistics, scenario and evaluation creation
Hold the pediatric mock code
Evaluate feedback from participants and
program members
Analyze feedback and report
suggestions to staff and
management
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RESOURCES
Resources available to you and your program
Mock code video scenarios
Pediatric Mock Code Toolkit
Train-the-Trainer PowerPoint Presentation
All resources are available online at www.luriechildrens.org/emsc
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REFERENCES
1. Topjian AA, Berg RA, Nadkarni VM. Pediatric cardiopulmonary resuscitation: Advances in science, techniques, and outcomes. Pediatrics. 2008 Nov;122(5):1086-98.
2. Andreatta P, Saxton E, Thompson M, Annich G. Simulation-based mock codes significantly correlate with improved pediatric patient cardiopulmonary arrest survival rates. PEDIATR CRIT CARE MED. 2011;12(1):33-8.
3. von Arx D, Pretzlaff R. Improved nurse readiness through pediatric mock code training. J Pediatr Nurs. 2010 10;25(5):438-40.
4. Hunt EA, Hohenhaus SM, Luo X, Frush KS. Simulation of pediatric trauma stabilization in 35 North Carolina emergency departments: Identification of targets for performance improvement. Pediatrics. 2006 03;117(3):641-8.
5. Mancini ME, Soar J, Bhanji F, Billi JE, Dennett J, Finn J, et al. Part 12: Education, implementation, and teams: 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2010 Oct 19;122(16 Suppl 2):S539-81.
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REFERENCES
6. Mikrogianakis A, Osmond MH, Nuth JE, Shephard A, Gaboury I, Jabbour M. Evaluation of a multidisciplinary pediatric mock trauma code educational initiative: A pilot study. J Trauma. 2008 Mar;64(3):761-7.
7. van Schaik SM, Plant J, Diane S, Tsang L, O'Sullivan P. Interprofessional team training in pediatric resuscitation: A low-cost, in situ simulation program that enhances self-efficacy among participants. Clin Pediatr (Phila). 2011 Sep;50(9):807-15.
8. Mann K, van der Vleuten C, Eva K, Armson H, Chesluk B, Dornan T, et al. Tensions in informed self-assessment: How the desire for feedback and reticence to collect and use it can conflict. Acad Med. 2011 Sep;86(9):1120-7.
9. Auerbach M, Kessler D, Foltin JC. Repetitive pediatric simulation resuscitation training. Pediatr Emerg . 2011 Jan; 27(1): 29-31.
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REFERENCES
10. Fanning RM, Gaba DM. The role of debriefing in simulation-based learning. Simul Healthcare. 2007 Summer;2(2):115-25.
11. Beaubien JM, Baker DP. The use of simulation for training teamwork skills in health care: How low can you go? Qual Saf Health Care. 2004 Oct;13 Suppl 1:i51-6.
12. Training Guide: Using Simulation in TeamSTEPPS Training retrieved 1.2012 from Link: http://www.ahrq.gov/teamsteppstools/simulation/index.html
13. Diane S., Tsang L, van Shaik, S.UCSF Children’s Hospital Mock Code Training PowerPoint 2011 by the Regents of the University of California. Used with permission.
14. Rudolph JW, Simon R, Rivard P, Dufresne RL, Raemer DB Debriefing with Good Judgment: Combining Rigorous Feedback with Genuine Inquiry. Anesthesiology Clin 2007 June; 25(2):361–376.
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THANKS!
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