TABLE 3

LSTs Identified

AreaThreatDiscussionPhase of Training
EquipmentTelemedicine setupPossible privacy concerns regarding the display (or lack thereof) of the camera view on the patient side were identified. Having an inset that shows what the ICU can see is crucial for the providers in the room in regards to positioning, etc, but it also helps ease privacy concerns for those in the roomIII
Telemedicine audioIt is difficult for the providers to hear the ICU (telemedicine) physician’s “tone” when they call in, which delayed communication in a few simulations. Can the volume, tone, or signal be modified?III
Telemedicine setupDefibrillator should be placed in view of monitor for ICU physician to help identify and manage rhythmsIII, IV
Code button sound/signalLeft on, this prevented ICU physician from hearing communication in the roomIV
Video laryngoscope would not plug into the wall outlet at the bedsideThis has a 2-pronged plug which will not go into wall outlets because these “safety” outlets require the 3 pronged plug. Thus, the video laryngoscope needs to be plugged into the power supply strip on the intravenous pole and then that strip needs to be plugged into the wall outletIV
Climber crib makes it difficult for the telemedicine (ICU) physician to see the patientNeed to turn the bed and lower all railingsIV
ResourcesCoverage for patients when RRT and/or Code Blue is calledHow will the development and implementation of the RRT and Code Blue roles impact patient care in other rooms and hospital locations?I/II
Documentation during emergencies or codesRoutinely was not done during simulations. We are working with the electronic medical record build team to develop 8 scenarios in playground that can be used in this training. This will help with abstraction of patient information, but will we expect providers to document in the electronic medical record during patient care? Currently, at the main campus, the code team is on paper; will that be the same at the satellite campus?I/II
Need a process for subspecialty escalationHow to contact oncology physician and/or team in an emergency, how to contact cardiology to read an electrocardiogram emergently, etc.I/II
Need a process of escalation before an RRT or Code Blue is calledSpecifically, will bedside nurses have a hierarchy to follow? For example, will the advanced practice nurse be called first and then the physician, if needed?I/II
Need process for getting emergent blood productsIt was noted that there would be a blood bank at the satellite campus, which is different because currently there is only 6 Us of O-negative blood on campusI/II
Need to develop process around managing the parents during emergenciesIt will be the manager of patient services’ responsibility, but early in a code, it may need to be the charge nurse (chaplain only available on weekdays, no child life available); security should also respond. Should social work respond to codes to help with this?I/II; IV
Need to develop process around activation of transportCurrently, the process is to call Statline at the main campus and speak with the transport person in charge of the units; will it be similar?I/II
Procedural careNeed for the Pediatric Emergency Dosing Code Book to be placed on code cartsBedside code sheets only have limited and specific code medications listed; during non-code emergencies, a resource for other medications is neededIV
Need a process (and policy) developed around the scope of practice for IO cathetersIt seems clinical managers are being identified as providers who can place IOs; currently, there is a policy (CPC-I-231) allowing trauma core nurses, satellite ED nurses and transport nurses to place IOs, which needs to be expanded to include some satellite floor providersI/II
Need to clarify the rapid sequence intubation processWill this be done the anesthesia way, the ICU way, or the ED way? The respiratory therapists are already knowledgeable and comfortable with the ED checklist/process. All of the teams asked for consistency independent of who the airway physician is and independent of time of day. What drugs are going to be available?III
MedicationsNeed anaphylaxis kit on code cartsThought of having EpiPen and EpiPen Jr to use for all kids >10 kg to reduce potential errors with drawing up 1:1000 epinephrineI/II, VI
Need a process around anaphylaxis medicationsWe can look to hematology and oncology for their current process because they have epinephrine, solumedrol, Benadryl, and prednisone in a prepackaged kitI/II
Plan for getting medications from pharmacy in an urgent or emergent situationWill there be a pharmacist present at any level of escalation? How will medications that are not in the code cart or the floor Pyxis get to a resuscitation? Will orders be entered into the electronic medical record by physician, advanced practice nurse, or nursing?I/II
  • IO, intraosseous.