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March 2012, Volume 42 Number 3 , p 60 - 61


  • Darla Banks MS, RN, CCRN
  • Kimberley Trull MSN, RN, CCAP-I


PATIENT SAFETY is a major concern of all nurses. The Joint Commission (TJC) identified communication breakdown as the root cause for most sentinel events.1 One example of a possible sentinel event is a long delay in the use of automated external defibrillators (AEDs) during a cardiopulmonary arrest. (In this article, we'll call cardiopulmonary arrest a "code blue.")The code blue committee at Texas Health Harris Methodist Fort Worth Hospital, a 710-bed tertiary care facility in an urban setting, identified that we needed to improve our use of AEDs as a strategy to improve patient outcomes. To improve communication and decrease the time to first defibrillation during a code blue, we implemented a process improvement strategy.This strategy educates code blue champions by using simulations and a communication framework. The champions then use their education to improve practice in their units and departments. This article describes how we implemented this project and our positive results. First, look at how direct care nurses experience code blue situations.In informal interviews with direct care nurses, we learned that they feel overwhelmed when dealing with a code blue, which they described as extremely stressful and chaotic. Stimuli-from distraught families, noisy alarms, shouting, and traffic-flood the patient's room. Setting priorities during a code blue is difficult because nurses are tense and have a harder time thinking clearly. Teams have difficulty working efficiently during a code.Among the nursing staff reporting their code blue experiences, many observed that first responders didn't use an AED soon enough or at all. Nurses raised their concerns that this delay could be contributing to a poor survival rate for patients who arrest in the hospital. This concern is substantiated in a review of the literature. One article published in The New England Journal of Medicine concluded that "delayed defibrillation is common and is associated with lower rates of survival

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