Code Blue Simulation Assignment Sample

Virtual Education and Simulation Training Centre

The basic life support is considered to be the most important aspect of the emergency department to reduce the chances of mortality. Healthcare professionals are expected to utilize their technical and non-technical skill during the patient assessment to improve the treatment procedure (Ralapanawa et al., 2016). The technical and non-technical coordination is required to help the patient they include clinical practice skills, teamwork, effective communication, correct equipment handling and social skills (Krage et al., 2017).

The Australian Resuscitation Council (ARC) guidelines aim to improve the resuscitation techniques for patient welfare and help the health care to follow a set of standards to provide accurate care to the patient. This guideline helps to understand the right technique to provide care to the patient and minimum health facility requirement for the patient (Grantham & Christiansen, 2016). After reviewing the video, multiple positive and negative aspects were identified concerning the care practice of the health care practice and the essay will compare the care practice concerning the guideline provided by the ARC.

The first aspect that can be analysed from the video is the lack of effective communication between the team members. The team member seems to have difficulty in interpreting the instruction given by the team leader that can increase the complication of the patient. One of the scenarios is regarding the dose of the amiodarone instructed by the leader seem to be unclear that increased confusion of the team members. The non-technical skill plays a role in basic life support and effective communication is one of the important aspects during teamwork.

The effective between team member help to take the rapid decision and it improves the teamwork that directly helps the patient health status (Gabr, 2019). Moreover, the article presented by Pun et al. (2015) communication is a key contributing aspect that helps health care professional to provide quality care and improve the health status of the patient. Effective communication helps the team to work in collaboration by utilizing individual expertise to meet the patient health requirement.

The next aspect that is predicted after analyzing the video is the excellent leadership skill of the team head during the intervention. The team leader was involved fully in the treatment and was allocating the duties to the entire team member to improve the care process. The accurate leadership quality is required to manage the collaboration between the team to provide the effective care to the patient and directive leadership style is preferred in the basic life support that utilizes the leader clinical skill which is utilized to guide the teamwork during the treatment process (Ford et al. 2016). The clinical leadership is considered to be a key aspect in nursing and nurses are expected to utilize their clinical leadership skill during patient treatment. The clinical leadership includes multiple aspects that should be used during treatment like reflective about their role, use of innovative technique, incorporation of new technique and promoting teamwork (Joseph & Huber, 2015).

One of the aspects that were noticed in the video analysis is ineffective CPR technique as the depth of the compression was not up to mark and there is severe inconsistency in the compression. The nurses involved in the is using the wrong technique as the hand placement used for the CPR is not followed and there was no rotation of the rescue team member involved in the CPR. The compression should be provided to the patient accurately and it should be consistent in terms of quality as wells quantity to improve the survival rate of the patient (ARC, 2016a). The hand position during the CPR should be accurate that include straightened arms, slightly lifted, locked elbows that help to assist the patient. The accurate compression rate for the patient is to be 100 to 120 per minute that is around 2 compressions per second (Kwon, 2019).

The team involved in the patient care accurately performed the DRSABCD (danger, response, send, airways, breathing, circulation and defibrillation) to understand the patient current condition. The leader of the team started the process by checking the response of the patient by calling his name twice after that she shook the shoulder to analyze the response of the patient. When the patient did not respond she immediately calls for the help that indicates that the leader effectively followed the proper guideline. The nurses are expected to check the responsiveness of the patient during basic life support and if the patient is found to be unresponsive then the nurse should call the team to assist the patient (Kondo et al., 2017).). The team leader firstly observed the surrounding of the patient to identify any risk that can hamper the safety concern of the patient. The rescue team should first check the surrounding environment of the patient to identify any risk that can increase the complication of the patient (ARC, 2016b).

After the video analysis, it was revealed that the team forget to follow the accurate process of the management of the airway as many flaws were identified during the treatment. The first flaw that was identified is the rescue team member providing the oxygen covered the nasal passage of the patient by her hand. The condition of the patient can be deteriorated due to covering of the nasal passage as it will interrupt in the gaseous exchange that can result in laboured breathing (Garg et al., 2017). The nurse did not use assessment to identify airways obstruction and the leader of the team instructed to bring airways bag without inserting the geudel. One of the important aspects of the patient assessment is to analyse the presence of the obstruction of the airways as it can lead to inflammation of the lungs that directly affect the breathing (ARC, 2016c). The geudel airways are one of the significant aspects during the CPR and it helps to reduce the chances of the falling back of the tongue that is responsible for the obstruction of airways (Castro & Freeman, 2020).

The video indicates that there was a lack of situational awareness during patient treatment as no one speck about some irrelevant procedures. The team does not determine the danger in the room, in misbalance in the compression and rotation of the nurse involved in the compression. The nurse involved in the CPR was unable to provide adequate compression that can help the patient and she was using the wrong technique during CPR. The correct compression process involved lower half of the sternum should be depressed up to one-third of the chest during each compression and it should about 5cm in adult or children (ARC, 2016a). The leader is expected to maintain the clinical practise accuracy of the team and he/she should interrupt the team member during the wrong clinical practice (Solman, 2017).

The individual involved in the CPR should be exchanged during the process to maintain the intensity of the compression. The individual involved in the chest compression should be exchanged after 2 minutes to maintain the correct intensity of the compression that is required to maintain the CPR. The compression depth is observed to deteriorate after 1.5 minutes thus increase the need to rotate the individual involved in the CPR process (Lee et al., 2018).

Good task management was observed in the video and the team leader was guiding the team member. The leader was trying to maintain the collaboration in the team by indulging every team member in the process. Basic life support is a complex process and proper teamwork is required to maintain the quality of care which helps the patient in the emergency state by reducing complication. The situational awareness is required to immediately utilize the clinical skill according to patient condition to deliver the best care process (Hammett, 2019). The leader allotted the task to the team according to their expertise and utilized their skill to help the patient in need. Good task management helps the team to deliver the best care as the task are allocated accordingly by using the best situational awareness which leads to better teamwork (Panchal et al., 2018).

After the video analysis, it was revealed that the defibrillation process was conducted well bit the placement of the pad was not accurate that can hamper the process. The correct placement of the pad is the anterior-lateral position that directly delivers the shock throughout the heart. During defibrillation one pad should be placed below the collar bone on the right side and second pad should be positioned below the armpit of the left side (ARC, 2016d). The cardiac defibrillation is considered to be the transthoracic electrical current experience to the person to help the dysrhythmias. The pad location observed in the video was not right and during the treatment, no one corrected the nurses to utilize the current pad position to improve the rhythm of the heart. The current location of the pad during the defibrillation is required to maintain the effect of the process that can help the individual to maintain the proper rhythm of the heart (Goyal et al., 2020).

The medical treatment prescribed for the patient was also questionable that was observed after the video analysis. The medication that was used for the patient was 1mg epinephrine IV and it was commenced by the leader of the team. The drug that is suitable for the cardiac arrest includes amiodarone 300mg IV that directly help to improve the defibrillation response occurred in the patient which lead to a better response of the patient (ARC, 2016e). The medication for the patient in the emergency department should be according to the health status of the individual as carelessness in the medicine can lead to an adverse event that can directly deteriorate the health status of the patient. Epinephrine administration can lead to an adverse event in the patient like vasoconstriction, metabolic disarrangement and tissue hypoperfusion. Another side effect of the medicine includes chest pain, hypertension, tachycardia, vasospasm and tissue ischemia (Dalal & Grujic, 2020).

After the video assessment, different aspects of the video were discussed that include both positive and negative aspect. The positive aspect related to the video includes good leadership quality of the team leader, good assessment skill of leader and good task management. On the other hand, negative aspect analysed after the video analysis revealed health care professional carelessness includes medication error, incorrect CPR technique, wrong placement of defibrillation pads, incorrect airways management and lack of effective communication. The lack of technical and nontechnical skill was observed in the video that requires urgent attention to reduce the complication of the patient.

References for Code Blue Simulation

ARC. (2016a). ANZCOR Guideline 6 – compressions. Retrieved from https://resus.org.au/guidelines/#

ARC. (2016b). ANZCOR Guideline 8 –Cardiopulmonary resuscitation. Retrieved from http://www.hpw.qld.gov.au/SiteCollectionDocuments/AnzcorGuideline8CPRJan16.pdf

ARC. (2016c). ANZCOR Guideline 4 – Airway. Retrieved from https://resus.org.au/guidelines/#

ARC. (2016d). ANZCOR Guideline 7 – Automated external defibrillation in basic life support. Retrieved from https://resus.org.au/guidelines/#

ARC. (2016e). ANZCOR Guideline 1.15 –Medications in adult cardiac arrest. Retrieved from https://resus.org.au/guidelines/#

Castro, D. & Freeman, L. A. (2020). Oropharyngeal Airway. Treasure Island, United Kingdom: StatPearls Publishing.

Dalal, R. & Grujic, D. (2020). Epinephrine. Treasure Island, United Kingdom: StatPearls Publishing.

Ford, K., Menchine, M., Burner, E., Arora, S., Inaba, K., Demetriades, D., & Yersin, B. (2016). Leadership and Teamwork in Trauma and Resuscitation. Western Journal of Emergency Medicine, 17(5), 549–556. DOI:10.5811/westjem.2016.7.29812

Gabr, A. K. (2019). The importance of nontechnical skills in leading cardiopulmonary resuscitation teams. Journal of the Royal College of Physicians of Edinburgh, 49(2), 112-116.

Garg, R., Ahmed, S. M., Kapoor, M. C., Rao, S. C., Mishra, B. B., Kalandoor, M. V., Singh, B. & Divatia, J. V. (2017). Comprehensive cardiopulmonary life support (CCLS) for cardiopulmonary resuscitation by trained paramedics and medics inside the hospital. Indian Journal of Anaesth, 61(11), 883-894.

Goyal, A., Chhabra, L., Sciammarella, J. C. & Cooper, J. S. (2020). Defibrillation.Treasure Island, United Kingdom: StatPearls Publishing.

Grantham, H. & Christiansen, R. (2016).Resuscitation update for general practitioners. Australian family physician, 45(12), 879- 883.

Hammett, E.(2019). A guide to resuscitation and emergency life support. BDJ Team, 6(19012), 10-12. https://doi.org/10.1038/bdjteam.2019.12

Joseph, L., & Huber, D. L. (2015). Clinical leadership development and education for nurses: prospects and opportunities. Journal of Healthcare Leadership, 2015, 55-64. DOI:10.2147/jhl.s68071

Kondo, Y., Fukuda, T., Uchimido, R., Hifumi, T., & Hayashida, K. (2017). Effects of advanced life support versus basic life support on the mortality rates of patients with trauma in prehospital settings: a study protocol for a systematic review and meta-analysis. BMJ Open, 7(10), e016912.DOI:10.1136/bmjopen-2017-016912

Krage, R., Zwaan, L., Len, L. T. S., Kolenbrander, M. W., Groeningen, D. V., Loer, S. A., Wagner, C. & Schober, P. (2017). Relationship between non-technical skills and technical performance during cardiopulmonary resuscitation: does stress have an influence? Emergency Medicine Journal, 34 (11), 728-733.

Kwon, O. Y. (2019). The changes in cardiopulmonary resuscitation guidelines: from 2000 to the present. Journal of Exercise Rehabilitation, 15(6), 738–746.

Lee, S. D., Hong, J. Y., & Oh, J. H. (2018). Why should we switch chest compression providers every 2 minutes during cardiopulmonary resuscitation? Signa Vitae - A Journal In Intensive Care And Emergency Medicine, 14(2), 31-34. DOI:10.22514/sv142.102018.4

Panchal, A. R., Berg, K. M., Kudenchuk, P. J., Del Rios, M., Hirsch, K. G., Link, M. S.& Donnino, M. W. (2018). American heart association focused update on advanced cardiovascular life support use of antiarrhythmic drugs during and immediately after cardiac arrest: an update to the American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 138(23), 740–749. DOI:10.1161/cir.0000000000000613

Pun, J. K. H., Matthiessen, C. M. I. M., Murray, K. A., & Slade, D. (2015). Factors affecting communication in emergency departments: doctors and nurses’ perceptions of communication in a trilingual ED in Hong Kong. International Journal of Emergency Medicine, 8(48), 1-12. DOI:10.1186/s12245-015-0095-y

Ralapanawa, D. M. P., Jayawickreme, K. P., Ekanayake, E. M. M., & Kumarasiri, P. V. R. (2016). A study on the knowledge and attitudes on advanced life support among medical students and medical officers in a tertiary care hospital in Sri Lanka. BMC Research Notes, 9(462), 1-11. DOI: 10.1186/s13104-016-2270-5

Solman, A. (2017). Nursing leadership challenges and opportunities. Journal of Nursing Management, 25(6), 405–406. DOI:10.1111/jonm.12507

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