Team-Level Knowledge Deficits Identified

AreaDeficitDiscussionPhase of Training
EquipmentUse of defibrillatorHow to turn on to monitor (not automated external defibrillator) mode; use of sync button for cardioversion; defined need for additional defibrillator training for staff before the openingI/II, III
Code cartsStaff consistently gave feedback that at the main campus they “move away” when the code team arrives, so if they are going to be part of codes at satellite campus, they need to be knowledgeable about the code cart (contents, location, use of equipment, etc); specific needs such as where the backboard is located, side wing usage, and how to use bristojets (especially how to mix dextrose)I/II, III
HFNCWhat the indications for HFNC are, how to use and set up the machine, and how to interpret the patient as a “responder” to high flow; this is important because there is no HFNC on the floors at the main campusI/II, III
ResourcesScope of practiceResponsibility for placement of IO catheterIII
Bedside code sheetsStaff not familiar with code sheets because they do not routinely use themI/II
Orders during resuscitationHow are orders entered into the electronic medical record? Who puts them in?III
Procedural careIOTechnique, equipment needed, sizing, and location for placement of IO catheter (including how to flush after placement)I/II, III
Cardiopulmonary resuscitation (here pertaining to chest compressions)Providers felt that basically all staff need training in cardiopulmonary resuscitation (here pertaining to chest compressions) above what is learned in and maintained from basic life support and pediatric advanced life supportI/II
Push-pull method for fluid bolusesHow to set up and use for expedient administration; for continued training, the registered nurse educator has skill days planned to educate the registered nurses to ensure competencyIII
MedicationsEpinephrine delivery in anaphylaxisSubcutaneous versus intramuscular versus IO or intravenous; dosing for each routeIII
Confusion surrounding rapid sequence intubation and narcotic “kits” or pouchesWhere will they be stored? Who will get them and bring to the bedside? What medications will be available in them? What medications will not?III, IV
  • HFNC, high flow nasal cannula; IO, intraosseous.