Code blue is a common term to indicate a medical emergency. There is nothing quite like a code blue alarm to strike attention in the heart of a registered nurse. It is imperative to keep a cool head during a resuscitation event. As nursing professional development (NPD) practitioners, we are tasked with helping our teams find a way to control their response to be able to function efficiently and calmly.

A well-run code blue with positive outcomes is always the goal. Ideally, a code situation should occur in an environment where staff are confident about the sequence of events and have Advanced Cardiac Life Support (ACLS) training. Unfortunately, having a perfectly run code blue on a medical/surgical (medsurg) unit can be a rarity. One reason: the situation is in frequent. A goal for NPD practitioners is to increase familiarity with code response to improve staff’s performance and positively impact patient outcomes.

In our community hospital, the nurses in the med/surg overflow unit had concerns that they would not perform at peak efficiency in a code blue. The clinical nurses brought this concern to their Professional Practice Council, who contacted me to address potential knowledge and skill gaps. While a code event is consequential and serious, learning how to deal with one should not be. A team of experienced nurses from the unit teamed up with me to put together practice sessions with the goal of improving nurse comfort and familiarity with code blue. After brainstorming, we leaned into the Halloween season, and our workgroup of clinical nurses decided to adopt a “Mocktober” event theme with the slogan: “Don’t be Afraid of Code Blue.”

One learning outcome identified was to increase team dynamics. When debriefing real-time code blue situations, it was noted that team members did not know what role was required of them and no clear team leader was assigned to direct the code. When deciding on a learning modality to improve this, the team chose an escape room format and designed it to mirror the Halloween theme. This style of learning can be very engaging for participants and builds the desired teamwork needed for code blue events as they work together to solve the puzzles and escape. Gamification can reinforce the importance of coordinating efforts and recognizing tasks that need to be done, including delegating to other players, similar to nursing.¹

The team designed a series of puzzles to be solved in order, like an actual code blue in which specific basic life support tasks must be performed in sequence. Chosen puzzles to be solved included:

• Is your Patient a Ghost? Identifying unresponsiveness and pulselessness.
• How Do You Rate? Providing chest compressions at the correct rate.
• Where’s Your Tombstone? Concurrently placing the backboard.
• Did you Crash Your Cart? Crash cart and monitor at the bedside and pads correctly placed.
• Paging Dr. Frankenstein: Recognizing lethal rhythms with the automated external defibrillator (AED) and intervening as needed.

We used locks with a code specific to each puzzle, for example there was a lock on the chest, and the participant had to know the correct rate of chest compressions to remove it. Several sessions were planned over the course of one week and leadership support allowed 100% of the unit staff to attend. This included the patient care technicians, who may be initial responders and therefore need training in important first steps.

In addition to the escape room, the team decided to integrate practice sessions. This met both goals of improving teamwork and increasing familiarity with response roles. During the sessions, a leader for the code was identified and the participants took turns directing the resuscitation activities to practice clear communication, sequencing of events, and hands-on experience. There were several practice sessions within each group and debriefing was held after every session. This served as a way for participants to clarify situations that arose during the mock codes and allow time to discuss any prior experiences, good or bad, they had with code blue. It is vital as educators that we recognize when our material may be stressful to participants and give people the opportunity to discuss. According to the Association of Standardized Patient Educators' Standards of Best Practice, “feedback is critical to learning.”²

An evaluation was sent out to all participants after all the sessions were completed. We asked what went well, what could be improved upon, and what other topics should be covered. Of the 45 participants, nine responded to the survey. The most frequent feedback indicated teamwork as a positive element of the activity. When asked what to improve, respondents wrote in that they wanted more mock code scenarios in future education. When responding about what they would improve upon, the most frequent feedback indicated they wanted more time and more in-depth explanation of the code event.

Using AI to Build Training

Of particular interest to me as an educator was the use of our in-house Microsoft AI program known as Copilot. With the AI, I had created everything I needed for the escape room from start to finish in less than an hour. It all started by asking AI to create a code blue escape room for hospital staff. This tool is especially useful in situations where you do not know how to start. Having never created an escape room from scratch, I had no idea where to begin. Even with the help of AI, it took several hours of planning, practice sessions, and additional fine-tuning to guarantee success. Our first few attempts were by no means flawless, and we learned as we went along.

Overall, the initiative was a solid success and a positive example of collaboration between education, our Professional Practice Council, and the team members to fulfill a learning need. This learning activity demonstrates the benefits of Standard 5-A of the NPD Scope and Standards of Practice: Coordinates implementation of the plan, including activities and resources necessary to achieve desired outcomes.³

References

1. Tassemeyer, D., Rowland, S. & Barnason, S. (2021). Building a Nursing Escape Room: An Innovative Active Learning Strategy. Nurse Educator 46(5), p. 271-272. Wolters Kluwer Health, Inc.
2. Lewis, K, et.al. (2017). Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP). Advances in Simulation 2(10). DOI 10.1186/s41077-017-0043-4.
3. Harper, M. & Maloney, P. (2022). Nursing Professional Development Scope and Standards of Practice, 4^th ed. Association for Nursing Professional Development.