Effective crisis resource management (CRM) and adherence to current ACLS algorithms within the interdisciplinary Code Blue response team is integral to OHSU’s ongoing commitment to quality patient care.
The purpose of Simulated Code Interdisciplinary Team Training (SCITT) is to train high performing teams to respond quickly and safely in cardio-respiratory arrest situations. The goal of the SCITT program is to improve safety, reliability and patient care by improving communication and avoiding errors. The Code team at OHSU is an interprofessional team that includes a Critical Care Fellow, Anesthesiologist, Respiratory Therapist, Pharmacist and three ICU RNs.
The SCITT session
The SCITT session is an interprofessional mock code followed by a facilitated debriefing session.
- Duration: 1 hour session that include mock code, debrief, and evaluation
- Frequency: 2-3 times per month
- Locations: In-situ; locations vary
- Mock Sessions: Code Blue, involving scenarios with simulated cardiac arrest victims
- Emphasis of the program: is on crisis resource management (CRM) principles and advanced cardiac life support (ACLS) protocols.
- Who is involved: Everyone that carries a Code Blue pager
The SCITT program is mandated by the OHSU Hospital and Professional Board
CRND (Code Responder Nurse Development)
The Code Responder Nurse Development (CRND) committee was developed to identify and address nursing issues related to code response and to provide annual team training for code responder nurses. Membership includes representatives from the Rapid Response Team, the Medical ICU, the emergency development and acute care. CRND meets monthly and is actively involved in efforts to improve code response. Past initiatives include implementation RN to RN follow ups after code blue events and development of First Responder Nurse Development training for acute care and clinics.
FRND (First Responder Nurse Development)
First Responder Nurse Development (FRND) is a program developed by the Code Responder Nurse Development (CRND) committee to provide hands on code training for acute care and clinic nurses. FRND sends two code responder nurses to areas that request training. We provide training specifically designed for the location and patient population of the area requesting the training. During FRND training we review when to call a code versus the rapid Response team. We review how to call a code in any given area and what to do until the code team arrives. Emphasis is placed on performance of high quality CPR and early defibrillation of a shockable rhythm. Most FRND training include a low fidelity simulation with manikin, a fully functional code cart and either an AED or defibrillator.
Effective crisis resource management (CRM) within the interprofessional Code Blue response team is integral to OHSU’s ongoing commitment to quality patient care. Errors in communication are more likely to occur and may adversely affect patient care in crisis situations, such as codes. In one Joint Commission study it was stated that 72% of errors were related to communication.
SCITT was developed in response to this need to improve the fundamental skills in communication, build teams and review ACLS algorithms. The SCITT program is "in-situ" (inpatient areas) hospital simulation training for interprofessional teams.
Calendar of events
The SCITT Teams that run the mock code consist of:
- 2 Debriefers: One ACLS Instructor (M.D. or R.N.) and one CRM expert (M.D. or R.N.)
- 1 Simulation Technology Expert: Management of the patient simulator and computer simulation software and AV (M.D., R.N., or other)
- 2 Actors: Two actors playing the part of the typical first responders (acute care R.N.s)
SCITT Committee Chairs
SCITT Committee Members
- Podium Presentation and hands on "Simulation Code Interdisciplinary Team Training" Kelly Stafford (Cyndi Perez) and Michele Noles, Northwest Nursing Education Institute, June 14th, 2011
- Poster presentation SCITT: Simulation Code Interdisciplinary Team Training , Oregon Nursing Research & Quality Consortium-"Transform your Practice: Strategies for Clinical Inquiry", April 2011
- Poster presentation SCITT: Simulated Code Interdisciplinary Team Training (Perez, Noles, Gavilanes, Gordon, Gorsuch) Seattle Nursing Research Conference, January 2011
- Panel Presentation: "Train Them Where They Live: An Interprofessional Approach to 'In-Situ' Simulation," with Mary Anna Gordon and Michele Noles, Northwest Nursing Education Institute, June, 2010
- Designed and implemented Poster presentation SCITT: Simulated Code Interdisciplinary Team Training ( Perez, Noles, Bowden, Brown, Coates, Corcoran, Gavilanes, Gordon, Gorsuch, Mitchem, Nonas, Stafford, Watters). OHSU Hospital Respiratory Therapy In-service, Fall 2010
Code Responder Nurse Development
In 2007, the Code Responder Nurse Development (CRND) committee was created to identify the needs of the code responder nurses. The CRND committee discovered that roles and responsibility, leadership, communication, teamwork, resource management and crowd control needed to be defined.
The CRND group was formed to begin addressing some of the code blue team needs. The CRND group is made up of three nurses from two adult intensive care units, 8C CSICU and 12K CMICU. Each of the units selects about 24 nurses to represent the CRND group on the code blue team. As members of the code blue team, the CRND group is responsible for assessing the scene on arrival using the assessment basics checklist, assume one of three roles: (1) Defibrillation, (2) Documentation, and (3) Drugs, and integrating crisis resource management concepts.
In collaboration with HES, the CRND committee delivers an elaborate annual training program to develop code responder nurses who are 50% of the code blue team. The CRND program is in its sixth year of implementation. The goal is to provide annual training using simulation to address code responder nurse performance, confidence and satisfaction. Through the efforts of HES and the CRND committee policies and systems were updated, staff performance, confidence and satisfaction improved, and new programs were created like the Simulated Code Interdisciplinary Team Training (SCITT) program.
In 2011, the CRND committee merged with the SCITT committee in order to continue multidisciplinary collaboration. The CRND representatives from the adult intensive care cluster participate in SCITT and CRND meetings and trainings. The CRND committee is still responsible for developing and delivering annual training to the CRND group.
The CRND Session
- Duration: 4-hour sessions that include didactic, technical skills station, mock code, debrief, and evaluation
- Frequency: Annual
- Locations: In-situ (locations vary) and the Simulation and Clinical Learning Center (SCLC)
- Assessment Basics Checklist (links to document)
3-D Roles (links to document)
Additional resources for reviewing can be found here
The SCITTs take place in our hospital setting In Situ, which in Latin means 'in place' and in this context refers to the specific location in the hospital setting.
According to training goals, vacant rooms/areas are identified (acute care, ICU, procedural or diagnostic areas). Once a location has been identified, room set up, mock code, debrief and clean up all occur in less than two hours.