When a resident suffers a cardiac arrest in the facility, do nurses know how to initiate a code? If a resident elopes, do facility staff know what to do? When emergency events happen, such as a cardiac arrest or an elopement, it is imperative that staff know how to respond and that the response occurs promptly to ensure the resident’s safety. It is the director of nursing services’ (DNS’s) responsibility to provide opportunities for the staff to practice and perfect their responses to these emergency events. This article will discuss a framework the DNS can use to develop mock drills for both code and elopement situations to provide such opportunities.
Why Conducting Mock Drills is Important
Ensuring staff know what to do in an emergency is imperative to resident safety. Mock drills not only provide the means for staff to practice their roles, but also provide the DNS an opportunity to evaluate staff competency in emergency situations—recognizing and developing strengths, and identifying areas that need improvement. Mock drills also provide opportunities to:
- Keep staff members’ skills sharp in a non-threatening learning environment
- Ensure that equipment and medications are available and that staff members know where to find them and how to use them
- Clarify the roles of team members and ancillary staff during an emergency situation
- Establish a plan to maintain order
(Nursing2004). Mock drills are useful tools that contribute to the overall objective of maintaining or improving quality of care for the residents.
Preparing to Conduct a Mock Drill
Conducting a good mock drill takes preparation. Drills should be planned in advance and conducted at least on a quarterly basis. Because emergencies don’t happen only on weekdays during the day shift, it’s important that the DNS varies the times and days of each drill so that they are conducted on all shifts, weekdays, and weekends, and all staff are included. Utilize a competency checklist, such as the one found in AAPACN’s Emergency Drills: Code and Elopement Toolkit, to determine staff competency during the drill. Once the timing of the mock drill has been determined, the steps below guide nurse leaders through preparations for mock code and mock elopement drills.
Mock Code Drill
- The DNS should create a pseudo-medical record to use during the drill. Staff will confirm the code status using this medical record. The DNS will use the resident’s age and a list of diagnoses, allergies, and medications to report basic information to the emergency responder. Staff assigned to call the physician and responsible party can pretend to make these calls, should the facilitator want to include them as part of the mock code. The pseudo-medical record should include:
- Resident name and age
- Physician name
- Code status
- Physician order for code status
- Responsible party name and contact number
- List of diagnoses, allergies, and medications (keep simple and brief)
- The DNS should assign staff to play the role of the emergency responder so that the nurse leading the mock code can practice handing off the resident, thus ending the code.
- The DNS should place a manikin that represents a resident somewhere in the facility or in a location staff would be involved in performing the code, e.g., in a facility transport van or the courtyard. Place a sign that says “I am unresponsive” or the facility’s name for the code on the “resident” so staff know to initiate the drill. If the facility does not have a manikin, pillows may be utilized to represent the resident.
- The DNS should develop a script the facilitator will follow during the mock code. It should include prompts that give staff the resident’s name and other information for the facilitator to call out during the code. See an outline of an example script in AAPACN’s Emergency Drills: Code and Elopement Toolkit, to determine staff competency during the drill.
Mock Elopement Drill
- The DNS should create a pseudo-medical record and pseudo-elopement book information page to use during the drill. The DNS will use the resident’s age and a list of diagnoses, allergies, and medications to provide basic information, along with a picture, to the staff and authorities. The pseudo-elopement book information page should be completely filled out as the facility would for an actual resident. The pseudo-medical record should include:
- Resident name and age
- Physician name
- Responsible party name and contact number
- List of diagnoses, allergies, and medications (keep simple and brief)
- Staff assigned to call the police can pretend to make this call, should the facilitator want to include this as part of the mock elopement drill.
- The DNS should assign staff to play the role of the police so the nurse leading the mock elopement drill can practice handing off the information, thus ending the elopement drill.
- The DNS should place a manikin or other object, such as a stuffed animal, that represents a resident somewhere in the facility or in a location staff would be involved in performing the search, e.g., in a facility transport van or the courtyard. The DNS should place a sign that says “I have eloped” or the facility’s name for the elopement code on the “resident” so staff know when they have located the resident.
- The DNS should notify a staff member that a “resident” is missing to initiate the mock elopement drill.
How Did the Drill Go?
Once the drill has been completed, the DNS should conduct a debrief with the team. A debrief is an analysis of an event, led by a facilitator, to enable the team to reflect on the experience as well as their performance as individuals and as a team. The analysis and reflection enable staff to gain knowledge and improve their practice. Discussion questions posed during a debrief may include:
- What went well working as a team? – Did a nurse take the lead role? Was communication to staff clear? Did staff help other teammates?
- What could be done to improve teamwork? – Do staff need more education regarding the facility’s policy and procedures?
- Did staff demonstrate competencies well? – Did staff follow the facility’s policy and procedures?
- What can be done to improve competencies? – Do some staff members need one-on-one education?
- What processes worked? – Did staff find equipment easily? Was it in working order? Are procedures easy to follow?
- What gaps, if any, in processes were identified? – Are the facility’s policy and procedures confusing or hard to follow? Do they need to be clarified or streamlined?
- What can be done to eliminate these gaps? – Are resources easily available to staff?
In closing, the DNS should remember that staff are not going to perfectly perform every time, and this is okay—the team is practicing to improve their skills. The dancer Martha Graham once said, “Practice means to perform, over and over again in the face of all obstacles, some act of vision, of faith, of desire. Practice is a means of inviting the perfection desired.” This encapsulates the reason to conduct mock drills in the nursing home: the drills are a means of working toward perfection so that when a real emergency happens, the team will be ready.
References
Nursing2004. (2004). Mock code, real value. Nursing2004, 34(5), 12.
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