By Janlyn Rozdilsky, RN, CNE, PICU

“Pediatric Code Navy” is the overhead page for mock pediatric code-blue situations. These pediatric emergency training codes use high-tech computerized mannequins to simulate patient emergencies right in patient care areas.

These codes began in January 2015 and involve first response by the ward medical and nursing teams, and by the Pediatric Code Team when they are required and called.  

Pediatric Code NavyBy using simulation in actual patient care environments, the multidisciplinary team is not only able to practice skills, and gain knowledge, they are also able to ensure the system processes and equipment involved in emergency situations functions optimally. Technical support for these scenarios is provided by the Sim Lab staff from Health Sciences Clinical Learning Resource Centre (CLRC) at the University of Saskatchewan.

The Pediatric Code Navy enables medicine, nursing and respiratory therapy to respond to events as they would in any actual resuscitative circumstance and consult with any needed supports such as anesthesia specialists, social work, and x-ray. Scenarios are developed to focus on specific learning objectives, such as airway management or recognition of shock. Facilitators assume the roles of parents or ward medical or nursing staff. These facilitators initiate the “call for help” and provide background and patient history. Mock charts are also provided as additional sources of patient information.

The mannequins used for these simulations have many true-to-life features such as pulses, breath sounds, pupil response, and “Hal”, the school-age mannequin, responds to questions about his symptoms, which encourages realistic scenario evolution with minimal guidance and interruptions from the facilitators.

As education is the focus of these scenarios, other staff are permitted to observe and may be called upon to help out. Following the session, group debriefing is guided by one of the facilitators.

While knowledge of emergency management and correct skill demonstration are important, leadership, roles, responsibilities and team communication are equally important aspects of these learning exercises. To enhance focus on communication, some scenarios have had the medical team leader blindfolded to enhance their focus on role delineation, task assignment and communication of assessments and therapies.

Emergency response systems such as call bells and switchboard paging are tested during the Code Navy. Any problems, such as broken call bells,  or signage asking for added precautions, have been identified and changes made to ensure scene safety. Debriefing feedback has led to improvements to equipment availability and educational sessions reviewing the management of the conditions presented in the mock codes.

While the mock codes are limited to 15 to 20 minutes and debriefing to 20 minutes, the busy winter season resulted in limitations as to when and where they can be accommodated while maintaining patient safety. Families and patients in any adjoining area are briefed prior to the mock as to what will be happening and debriefed following to address any concerns that might have arisen.

Pediatric mock-codes have positive impact on knowledge and skill of those providing care to pediatric patients and have helped identify areas for improvement in patient care systems.

Staff have come to expect these calls-to-action as a way of continuous improvement practice.