Code blue: Overcoming the fear
Maria Christabelle Castro MSHA, BSN, RN, CCRN, NE-BC
Milagros Cruz BSN, RN, CCRN
Ruben Briones BSN, RN, RN-BC

June 2014 
Volume 44  Number 6
Pages 65 - 67
  PDF Version Available!

CARDIOPULMONARY emergencies are high-risk, low-incidence events in long-term care (LTC) units. Many nurses find responding to a cardiac arrest a stressful experience that invokes insecurity and fear. We were concerned that nurses at the Community Living Center (CLC), an LTC unit for veterans located next to the main hospital, weren't confident in their skills due to the low incidence of cardiopulmonary arrests in LTC settings compared with the main hospital.The CLC is a homelike facility where veterans receive short- or long-term rehab, help with activities of daily living, and skilled nursing and medical care. We were concerned that RNs, LPNs, and unlicensed assistive personnel (UAP) at the CLC didn't meet the skills and competency expectations in a code blue. Because the CLC is a brisk 6- to 10-minute walk from the main hospital, responders to code blue situations and members of the critical care committee decided to assess the confidence of the CLC staff in code blue situations through simulation-based mock code drills. We implemented a two-phase educational program based on the latest evidence-based guidelines to improve nurses' responses to code blue situations and patient safety. We also extended simulation training to resident physicians and interns in the ICU who are part of the cardiac arrest team.The American Heart Association last updated the CPR and emergency cardiovascular care guidelines in 2010 based on the evidence evaluation process. These guidelines continue to emphasize the importance of high-quality, effective chest compressions and early defibrillation.1Studies of in-hospital staff performance show that retention of CPR skills is poor; as a result, training every 2 years is recommended.1 As with any skill, basic life support (BLS) and advanced cardiovascular life support (ACLS) skills require practice to ensure competence. When the quality of education is increased and training is more frequent, we believe CPR skills become natural and instinctive

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