Should you videotape mock codes?
Although opinions differ as to whether pediatric mock codes should be videotaped, experts agree the educational value of these sessions is significant. "They are a great learning tool, especially if feedback is provided shortly afterward," says Lynne G. Callahan, RN, MICN, CNIV, pediatric liaison nurse and pre-hospital care coordinator at Cedars-Sinai Medical Center in Los Angeles.
Here are two ways to provide valuable feedback after mock codes:
• Videotape the mock codes. At Cedars-Sinai Medical Center, every mock code is videotaped and taken into the ED conference room for review, says Callahan. Instead of identifying mistakes made by an individual nurse, Callahan offers a hint to jump-start the discussion process. For example, she may point out that a child has lost potentially 100 cc of blood volume and ask how the integrity of the blood volume can be maintained.
"If the participants are not able to see where I am going, then I will point out that the use of bullets will draw off a much smaller amount of blood volumes than using adult tubes," she explains. The adult tubes could potentially draw off an amount of blood that could compromise the perfusion status of the child, says Callahan. "I will hold up the adult tubes next to the bullets so that there is a visual other than the tape," she says. "This is much more effective than saying, Look at Nurse Lynne. She is using the wrong blood tubes.’"
Callahan includes words of praise. "I was able to stop the tape and point out that the nurse using the Broselow Tape was correctly measuring the infant," she says. "It was a good teaching point to show that we measure from the top of the head to heel of the foot." The videotapes are effective because they provide visual evidence for things done well and areas that need improvement, says Callahan.
• Verbally critique the codes. Mock codes aren’t videotaped at Christiana Care Health Services in Newark, DE, says David Salati, RN, pediatric care coordinator for trauma, emergency, and aeromedical services. "Since the mock codes move around the hospital, moving the video equipment around also would be too cumbersome," he explains. "We prefer to just do an immediate recap and debriefing."
There is an immediate critique afterward, attended by everyone who participated in the mock code. "If anything crops up during the mock code that is notable, or that we think everyone needs to be remediated on, we put out e-mails to the entire staff," he says. A group e-mail list is used to get the message out to ED nursing staff, as well as resident and attending medical staff, says Salati. "No response is required, but we consider it a part of one’s professional responsibility to keep current," he says. "E-mail is the most efficient way to disseminate information."
The critique immediately follows the exercise, says Salati. "It is considered central to the exercise, so the expectation is that all who participated will stay for it," he explains. Critiques can last anywhere from five minutes to much longer, depending on the amount of discussion and remediation needed, says Salati. First, the code leader does a self-critique covering strengths, weaknesses, and opportunities for improvement, followed by the other members of the team. The facilitator concludes the critique with any observations that weren’t made already, reinforcement of points discussed if necessary, and key learning points, he says.
One recent example is the potential for overventilation in patients, and the need to make sure the stomach is decompressed to facilitate good chest compression and ventilation, says Salati. "If you have lot of air in the stomach, you can get vomiting and aspiration from that, even around an endotracheal tube potentially, if it’s an uncuffed tube," he notes.
The problem of gastric distention is a recognized problem in resuscitation, which was noticed during real codes, Salati says. Mock codes were used to reinforce the need for gastric decompression, he explains. "We discovered that gastric decompression was something that a lot of people weren’t thinking about," he explains. "We needed to change the culture to include it as a routine part of the code, so we made a point of bringing it to everyone’s attention."
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