CPR, ACLS, NRP, PALS - As a nurse, you are likely familiar with some, if not all, of these acronyms. Early in your career, you were taught the skills to resuscitate a patient in cardiac or respiratory arrest. Every few years, you attend a class to review and renew your certification.

But is it enough? If your patient suddenly coded, do you feel comfortable with the training you have received? Do you know how to initiate the Code Blue? Do you know where supplies are located in your crash cart? Do you know how to operate your portable suction machine?


What about the other members of your resuscitation team? Can you function as a smooth unit? What if the code occurs overnight, when less senior staff are present?


In Situ Simulation Benefits


More and more, research is demonstrating that the key to successful and ongoing resuscitation training for medical staff is through the use of simulation. Simulation of different patient scenarios allows providers to practice their skills hands-on, receive real time feedback, and improve team communication.


In particular, a method of training called in-situ simulation has shown some real promise. In-situ simulation means “training in place”, where the practice scenario occurs within the normal clinical environment. During these sessions, providers carry out the “resuscitation” on their own units, using the the supplies and resources that are typically available to them.  Not only does this allow for providers to gain comfort in these situations, but it helps to identify knowledge gaps or technical issues that need to be addressed.


Identifying Safety Threats


In the Agency for Healthcare Research and Quality February 2014 Newsletter, an article discussed the benefit of in-situ training for Cincinnati Children’s Hospital Medical Center. 64 unannounced simulations were conducted across various shifts over 21 months. Providers used the available code carts to handle the scenarios.


The simulations revealed 134 previously unrecognized safety threats. In some situations, crash carts were not properly stocked or available with needed supplies.  As a result, the hospital now makes sure to stock every cart with portable suction, oxygen cylinders, and laryngeal mask airways. A medication error was also noted during their simulations, leading to a change in labelling and a system to double check medications.


Practice Makes Perfect

Additionally, giving providers this interactive learning opportunity has been shown to increase proficiency in handling high-risk scenarios. Watching a co-worker demonstrate how to use medical equipment or perform a skill will not produce the same level of learning as actually doing it yourself. Setting up a central line procedure tray, manipulating the dials on your portable suction machine, or performing chest compressions- physically performing tasks such as these during simulations will make them easier to carry out in a real code situation.


For example, in a study published in the Journal of Surgical Education, multidisciplinary trauma team members who experienced hands-on simulations showed a significant improvement in speed, teamwork and completion rates for handling resuscitations.


Continued exposure and practice is the key to safely and effectively manage resuscitations in your hospital. Mock codes and simulation scenarios are an excellent way to identify areas of weakness and gain familiarity with equipment and skills.