Assessment of the quality of pediatric cardiopulmonary resuscitation using the in situ mock code tool

Abstract

Objective: To evaluate the quality of individual and team care for cardiac arrest in a pediatric hospital using clinical surprise simulation (in situ mock code). Methods: We conducted an observational study with a sample of the hospital staff. Clinical simulations of cardiorespiratory arrest were performed in several sectors and work shifts. The mock code occurred in vacant beds of the sector without previous notification to the teams on call. One researcher conducted all mock codes and another evaluated individual and team attendance through a questionnaire contemplating recommendation for adequate cardiopulmonary resuscitation, based on the Pediatric Advanced Life Support (PALS) guidelines. At the end of the simulations, the research team provided a debriefing to the team tested. Results: Fifteen in situ mock code were performed with 56 nursing professionals(includingnurses,nursingresidentsandtechnicians)and11 physicians(includingtwopediatricresidentsandfourresidentsofpediatric subspecialties). The evaluation showed that 46.7% of the professionals identified cardiac arrest checking for responsiveness (26.7%) and pulse (46.7%);91.6%requestedcardiacmonitoringandvenousaccess.Inone case(8.3%)thecardiaccompressiontechniquewascorrectindepthand frequency,while50%performedcardiopulmonaryresuscitationcorrectly regardingtheproportionofcompressionsandventilation.Accordingto PALSguidelines,theteamshadagoodperformanceintheworkdynamics. Conclusions: There was low adherence to the PALS guidelines during cardiac arrest simulations. The quality of cardiopulmonary resuscitation should be improved in many points. We suggest periodical clinical simulations in pediatric services to improve cardiopulmonary resuscitation performance.