Miller 4 Strengthens Cardiac Arrest Response Skill

UVM Medical Center Miller 4 nursing staff group photo.


The staff on the inpatient cardiology unit are uniquely equipped to respond to cardiac arrests. Day in and day out, the nurses monitor telemetry, administer vasoactive medications and respond to subtle but important changes in patients’ health. Yet, despite their necessary advanced cardiovascular life support (ACLS) training and their ability to identify arrhythmias and provide the appropriate treatment, it was clear that many of the nurses lacked the confidence to lead an emergency situation while waiting for the rapid response/code team to arrive. The absence of formal unit-specific education days exacerbated the anxiety in leading a code situation in the crucial first few minutes. 

No one wants to make a mistake, especially when it could negatively impact a patient’s survival. However, these first moments do impact patient outcomes in emergency situations, and that is the reason for all of the training – the day in and day out.  So how to boost the confidence of well-trained staff to move from a timid participant to a bold leader in these situations? 

A group of nurses on Miller 4 utilized the NPG Taskforce model to create a consistent and repetitive educational opportunity for staff as it pertains to these emergency situations. Through a literature review, data was gathered on information retention post ACLS training, which supported the need for continued training to maintain the skill and knowledge necessary to respond appropriately. Various educational modalities were considered and in-situ training seemed a great opportunity for ongoing education since it did not require time off the unit. The taskforce team identified three areas of focus for the education: 

  • Identification of the rhythm 
  • Identification of the ACLS algorithm 
  • Identification of their role within the team.   

Surveys were conducted prior to the start of the mock codes to determine the staff’s confidence in identifying the rhythm, identifying the algorithm, and perception of the general atmosphere during emergency situations on the unit. Amy Teleron, MD (previously the Medical Director of Emergency Response Teams) provided guidance in establishing this method of training and wrote the scenarios. The UVM Clinical Simulation Lab provided training on how to debrief a simulation to optimize the learning experience. The taskforce team practiced scenarios as a group to enhance their own skills as simulators. 

After many months of preparation (and a COVID-19 hiatus), the taskforce team began to run in-situ mock codes on Miller 4 for the night shift, starting this fall. The response from staff is overwhelmingly positive. Anonymous surveys are conducted after each session to assess the learning experience and any change that may occur in staff’s confidence and competence after having participated in the education. The in-situ mock codes provide a great on-the-job learning opportunity which contributes to the improvement of patient outcomes through increased confidence and competence of first responders. 

UVMMC was awarded the 2020 Get with the Guidelines Gold Award for the fourth year in a row. The Get With The Guidelines-Resuscitation program was developed to help save lives of patients who experience in-hospital cardiac arrest by consistently following the most up-to-date research based guidelines and treatment. Shortening the time of effective resuscitation and maximizing post resuscitation care is critical to patient survival. Partners in Quality review and monitor compliance with the AHA guidelines and work to ensure patients are getting the best-possible care. The 2021 award status is expected to be announced early this summer -- meanwhile, the effort to always do better continues.