In situ simulations for protected code blue in the COVID-19 pandemic to detect latent safety threats

ABSTRACT

INTRODUCTION: With the emergence of Covid-19, a respiratory illness caused by the novel coronavirus SARS-Cov-2, a global pandemic has called for adjustments in hospital protocols and procedures in an effort to prevent spread of the virus, protect frontline healthcare workers, and preserve limited resources, such as personal protective equipment (PPE). One such important protocol was for protected code blue policy for hospitals dealing with cardiac arrests and potential AGMPs (aerosol generating medical procedures), deemed high risk requiring appropriate PPE and precautionary measures. We used in-situ simulation to aid in designing the new protected code blue protocol at our institution. METHODS: In our institution, a code blue policy was informed by American Heart Association and Heart and Stroke Foundation guidelines and Ontario Public Health Guidelines. It was however recognized that implementation of the protected code blue policy and judicious use of PPE would be very challenging. A quality improvement project was thus designed to utilize in situ simulations to train physicians, nurses and respiratory therapist in the different clinical units in the hospital and detect the latent safety threats that would hinder the safe implementation of the protected code blue policy. Iterative PDSA (Plan-Design- Study-Act) cycles were designed and implemented and at each stage the latent threats were identified and mitigated in the following domains- knowledge, personnel and staff, process, policy, systems issues, and medications. RESULTS: Over 80 in situ simulations were completed from March to June 2020. Latent safety threats such as effective communication, appropriate PPE use, personnel, overcrowding, intubation procedure and safety lead roles were identified and mitigated through policy changes, training and retesting. The simulations were time consuming and challenging but overall received good feedback and resulted in more compliance with the protected code blue policy. CONCLUSIONS: In-situ simulation is an effective modality in quality improvement, especially when rapid training is required and real-world threats must be identified and mitigated in a timely manner to optimize both patient and healthcare worker safety.