Digital Repository Masters Projects Spring 2024 Prepackaged Rapid Cycle Deliberate Practice Mock Codes Jennifer George Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON George, J. 2024. Prepackaged Rapid Cycle Deliberate Practice Mock Codes Weber State University Masters Projects. https://dc.weber.edu/collection/ATDSON This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact scua@weber.edu. WSU REPOSITORY MSN/DNP Prepackaged Rapid Cycle Deliberate Practice Mock Codes Project Title by Jennifer George Student’s Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY April 26, 2024 Ogden, UT Date Jennifer George, BSN, RN, MSN Student 4/26/24 Student Name, Credentials (electronic signature) Date Anne Kendrick, DNP, RN, CNE 4/26/24 MSN Project Faculty Date (electronic signature) 4/26/24 (electronic signature) DNP, N, CNE MSN Program Director Note: The program director must submit this form and paper. Date 1 Prepackaged Rapid Cycle Deliberate Practice Mock Codes Jennifer George, BSN, RN, MSN Student Annie Taylor Dee School of Nursing Weber State University MSN Project 2 Abstract Purposes/Aims: This project aimed to provide prepackaged rapid cycle deliberate practice (RCDP) mock code simulation scenarios to nurse educators for on-demand mock code team training utilizing the American Heart Association (AHA) algorithms. Rationale/Background: Intermountain Health Simulation frequently receives requests from clinical units to assist in providing mock code simulations for caregivers in a team training setting. Requesting simulation training from nurse educators and other healthcare providers can take 8-12 weeks and delay lifesaving training. Methods: Curriculum and tools were developed to train instructors, including ready-to-use RCDP prepackaged mock code scenarios. The curriculum can bridge the gap of delayed training while waiting for simulation requests to be processed and scheduled. A pre-mock-code and postRCDP mock-code participant survey will be given to each participant for feedback on the two methods of mock-code team training. Results: Three major themes are identified when implementing rapid cycle deliberate practice mock codes. RCDP 1) promotes early error correction in a safe and positive learning environment, 2) increases participants' confidence in delivering CPR, and 3) significantly improves team performance. Conclusions: By implementing a rapid cycle deliberate practice cardiac arrest simulation program for the healthcare team, participants can increase their knowledge of effective communication techniques, improve assessment skills, and become more confident in responding to CPR needs. Keywords: simulation, rapid cycle deliberate practice, mock code blue, prepackaged mock code, and AHA Get with the Guidelines 2020 3 Prepackaged Rapid Cycle Deliberate Practice Mock Codes In the United States, 21% of patients who suffer an in-hospital cardiac arrest (IHCA) will survive until discharge (Adcock et al., 2020). Survival after IHCA depends on two distinct phases: acute resuscitation and post-resuscitation (Girotra et al., 2020). The acute resuscitation phase is the responsiveness and quality of the hospital code team, and the post-resuscitation phase is the intensive and specialty care expertise. Immediate response and resuscitation are essential to reduce mortality and morbidity in patients who experience IHCA; code teams must be experts in this skill set (Adcock et al., 2020). Rapid cycle deliberate practice (RCDP) is an innovative team-based simulation method that is effective, particularly in cardiac arrest education (San et al., 2021). This strategy improves nurses' confidence and knowledge of cardiac arrest response. Merchant et al. (2020) stated that the 2020 Guidelines for Resuscitation Education include deliberate practice, spaced learning, teamwork, leadership training, in situ simulation, and cardiopulmonary resuscitation (CPR) feedback devices that improve teams and make a lasting difference. Perretta et al. (2020) quantified improved performance with RCDP. They sought to understand why this method is measurably more effective. RCDP enhances learner performance through contextual learning, constructivism and behaviorism, situated cognition, and social learning. Statement of Problem All Intermountain Health clinical units across Utah require unit-specific mock codes. Intermountain Simulation Volumes report shows that in 2023, over 59,000 participant hours were dedicated to simulation. Many of these hours are for code simulation (Intermountain Health, 2023). These requests are to have simulation support team training on the clinical unit (in situ) or to bring their team to the simulation lab for the mock codes. Clinical nursing units 4 require team training through mock codes at least yearly, and some units require this practice twice a year or quarterly. Processing and scheduling mock code simulation requests with Intermountain Health Simulation require a minimum of eight to twelve weeks. Stakeholders requesting simulation may decide on an outreach option once they identify that scheduling, planning, and implementing the simulation delays lifesaving team training. This project aims to provide prepackaged RCDP mock code simulation scenarios to nurse educators for on-demand mock code team training utilizing the American Heart Association (AHA) algorithms. The prepackaged RCDP mock code scenarios can bridge the gap between teams requesting mock code simulation and the time spent waiting for the simulation. RCDP is a simulation training that is gaining popularity to change clinical behaviors and improve patient outcomes (Perretta et al., 2020). San et al. (2021) indicated that RCDP is an innovative teambased simulation method that shows great promise and is effective in cardiac arrest education. Practicing code blue simulation with RCDP effectively increased nurses' confidence and knowledge in resuscitative care. Saravana-Bawan et al. (2019) explained that learning crisis resource management principles with low-fidelity simulation improves team training. Significance of the Project Required mock code team training is an added stress to the nurse educator who is balancing multiple educational needs. Ready-to-use RCDP prepackaged mock code scenarios with tools to train teams to respond to a code blue bridge the gap of delayed training as a simulation request is being processed and scheduled. An additional benefit is decreased strain on simulation resources. The learner-centered simulation instructional strategy identifies performance gaps and provides feedback to improve individual and team performance (Perretta et al., 2020). Simulation in the individual nursing unit is called in situ simulation. It allows 5 systems and space testing with the potential to discover opportunities to improve the work environment. The benefit for the team with this location is accessing unit equipment in its usual location. The educator can schedule this practice in a time frame and location that will meet the needs of the unit and team. RCDP can improve the team response, dynamics, and communication perception during the mock code, translating to an improved team response in the code blue (Saravana-Bawan et al., 2019). In addition, RCDP can help meet the AHA Get with the Guidelines 2020 of two minutes or less to shock a shockable rhythm or administer epinephrine as soon as possible for a non-shockable rhythm (Panchal et al., 2020). Review of the Literature This literature review explores healthcare teams' responses to (CPR) in adult and pediatric patients. RCDP is evaluated against traditional simulation in training teams. Advancing Research and Clinical Practice through Close Collaboration (ARCC) model is the framework for this evidence-based change project. Framework The ARCC model was the framework for this evidence-based practice (EBP) change project. Gawlinski and Rutledge (2008) outlined the specifics of this model. The key focus is the Utah Valley Hospital ICU. The key concept is that EBP mentors in RCDP will train and support bedside caregivers identified as mock code instructors. In preparation for this project, the twounit educators participated in a needs assessment to organize and determine readiness for EBP development of mock codes using the American Heart Association (AHA) algorithms. ARCC strategies for this project include developing and implementing a curriculum for EBP mentors. An interactive workshop for mock code instructors will be conducted to provide them with information to practice the curriculum and facilitate RCDP mock codes. Rounding on the mock 6 code instructors and assisting the mentors until they are comfortable as RCDP instructors will also be completed. The curriculum for on-demand RCDP mock codes will be implemented, and the data will be monitored for improvement in nursing teams responding to code blue events and system code blue outcomes. The ARCC model identifies that EBP mentorship positively impacts competency and implementation of EBP changes (Gawlinski & Rutledge, 2008). Additionally, mentorship impacts nurses' intent to stay in their positions (Melnyk et al., 2021). These mentors are developed into best-practice champions and are the team that continues to promote, support, and influence nursing best-practice guidelines. The model is also an effective strategy for the continued implementation and sustainability of evidence-based guidelines and care (Melnyk & Fineout-Overholt, 2019). Strengths and Limitations Melnyk & Fineout-Overholt (2019) identified the strengths of the ARCC model as being a very effective strategy for working with and engaging point-of-care clinicians in EBP to improve patient care delivery. This model facilitates the development of business plans and calculation for return on investment for the EBP changes that result in improved outcomes. Tucker et al. (2021) explained that the ARCC model's implementation component has evolved. It includes science resources and an EBP implementation and sustainability toolkit. This initiative guides an organizational culture through the process of implementation through reevaluation. This model supports the project in demonstrating the improvement of care, the cost-effectiveness of the training, and the impact on patient care and patient outcomes. Melnyk & Fineout-Overholt (2019) identified limitations for this model to thrive. It requires the adoption and backing of healthcare leaders, directors, and managers making 7 decisions about healthcare practices. Leaders need to be role models in their practice and decision-making. They must mentor, provide resources, and develop a mentoring program to accelerate and sustain this EBP in their health system. The ARCC model also gives limited direction on how the patient's values and preferences are combined (Dustin et al., 2023). Analysis of Literature This literature review explores the current literature for clinical response to adult and pediatric advanced cardiopulmonary life support resuscitation. This project aims to answer the question: For the healthcare team, does implementing prepackaged Rapid Cycle Deliberate Practice (RCDP) mock codes, compared to nurse educator-implemented mock codes, improve the perception of team dynamics in responding and performing as a team in a mock code? Search Strategies A literature search was conducted and identified current evidence on the topic. The search engines used were Google Scholar and OneSearch through the Weber State University Stewart Library, which included CINAHL, Medline, and PubMed databases. Articles from 2018 through 2023 were used in the literature review to keep the information current. The keywords and Boolean combinations used were: "simulation AND mock code AND prepackaged OR nurse developed simulation," "rapid cycle deliberate practice AND mock code AND prepackaged OR nurse developed," "simulation AND mock code AND American Heart Association get with the guidelines 2020," "simulation AND rapid cycle deliberate practice, and mock code" to start a broad search. Synthesis of the Literature Three major themes were identified in the literature: 1) RCDP promotes early error correction in a safe and positive learning environment, 2) RCDP simulation increases 8 participants' confidence in delivering CPR, and 3) RCDP significantly improves team performance. The major themes are further discussed in this section. Early Correction, Positive Learning, and Improved Skills Multiple studies showed that when hospitals implement an RCDP cardiac arrest simulation program, participants increase their knowledge, assessment, and confidence in response and communication during cardiac arrest (Lemke et al., 2019; San et al., 2021; Swinger et al., 2019). The learners cycle between deliberate practice and directed feedback until they have mastered skills before moving on to subsequent learning objectives (Ng et al., 2021). Donoghue et al. (2021) concluded that incorporating RCDP or mastery learning in resuscitation education can be associated with improved education and less skill decay than other educational methods. Won et al. (2022) determined that RCDP mock code practice in a team setting showed improvement in the subsequent replay of the practice method. Additionally, in this clusterrandomized trial comparing RCDP and post-simulation debriefing with thirty-two pediatric residents, the participants in the RCDP group had more than five times the odds of achieving defibrillation versus those in the post-simulation debriefing group. Jeffers & Poling (2019) developed a 12-month longitudinal simulation-based curriculum focused on instructional strategies of debriefing, the use of RCDP, and task training to improve core skills in pediatric emergency medicine fellows. In a research sample size of eight, 100% of the pediatric emergency medicine fellows participated in this curriculum, and learners had numerous opportunities to practice critical procedures such as airway management and defibrillator use. With this educational offering, learners self-reported a high satisfaction rate of 4.4 out of 5 and a perceived educational value of 4.9 out of 5. 9 Rosman et al. (2019) developed a low-fidelity simulation-based curriculum for pediatric residents in a resource-limited Rwanda setting using RCDP compared to traditional debriefing to determine which method leads to more remarkable improvement. They randomly assigned participants to the RCDP and the traditional model. They conducted a pre- and post-Likert scale survey that showed a 21% increase in pre-to-post-test performance in both groups (p < 0.001) and no difference between groups. Overall, self-confidence scores improved from the pre- to post (p < 0.001), showing no difference between RCDP and traditional groups. This research showed that RCDP and traditional low-fidelity simulation led to a statistically significant improvement in performance with simulated resuscitation and that low-fidelity simulation practice is a valuable tool for improving resuscitation skills. Confidence in Delivering CPR Chancey et al. (2019) conducted a qualitative analysis to evaluate participants' perceptions during RCDP learning in their pediatric emergency medicine rotation. In a study with a sample size of forty-four pediatric medical residents, the participants found RCDP pauses beneficial, and they reported that they learned most during their purposeful pauses and debriefing. Three themes were discovered in this analysis: (1) In-the-moment corrections during the RCDP simulation allowed for the learning and creation of new skills through repetition; (2) RCDP allowed learners to gain confidence, decrease anxiety, and learn in a safe environment; and (3) introducing new information in small chunks allows participants to learn without cognitive overload. Ismail et al. (2021) found that pediatric advanced life support (PALS) recertification was insufficient to maintain the pediatric hospitalist skills to lead the hospital's pediatric resuscitative efforts for cardiopulmonary arrests. This team developed a refresher curriculum that involved pauses and debriefing during the simulations. The procedural skills 10 portion of the simulation included expert and peer coaching. These skills were practiced over three sessions. The end-of-year survey showed that 96% of hospitalists rated the overall training quality as better or better than their PALS recertification simulation training. Their confidence level was significant (p <0.0001) with their perceived knowledge and skills. Powers et al. (2018) developed a skills course for nursing students in their senior year that follows the American Heart Association (AHA) advanced cardiac life support (ACLS) algorithms with mock code labs utilizing RCDP. Students were also allowed to become ACLScertified at the end of the semester. Students and the stakeholders found a positive correlation between students having the option to become ACLS certified in their nursing program before graduation and increased confidence in their ability to manage patients with cardiopulmonary arrest. They concluded that providing simulated mock codes and ACLS educational training can increase a nursing student's confidence and improve the preparedness of the BSN student in their final year of nursing school. Improved Team Performance Lemke et al. (2019) explained that with traditional simulation, more time is spent debriefing than running the scenario. RCDP allows the participants to practice their skills in the simulation, debrief, reset, and replay repetitively. The succinct discovery and feedback with RCDP significantly improved the participant's skills and team performance. Perretta et al. (2020) identified RCDP as a learner-centered simulation that identifies performance gaps and targets feedback to improve team performance. The evidence suggests that rapid cycle deliberate practice simulation can positively impact clinician performance. Pediatric cardiopulmonary arrest resuscitation is infrequently used in clinical practice. It is essential to be adequately trained in PALS training, including traditional pediatric simulation 11 (Swinger et al., 2019). Pediatric residents participating in traditional PALS simulation nine months after the initial training did not alter their 12-month performance (Surapa Raju et al., 2021). RCDP is efficacious in improving and maintaining PALS performance and skills. The pediatric residents team performance was maintained at 6, 9, and 12 months of refresher training. Swinger et al. (2019) also concluded that RCDP training showed significant improvements and high retention in pediatric residents' resuscitation performance. Summary of Literature Review Findings and Application to the Project Studies show that when hospitals implement a rapid cycle deliberate practice cardiac arrest simulation program for the healthcare team, participants increase their communication knowledge, improve assessment skills, and become more confident in responding to CPR (Crowe et al., 2018; Morton et al., 2019; Perretta et al., 2020). RCDP mock codes are versatile, can be run as a high-fidelity, fully supported simulation, and are equally effective in a lowfidelity simulation experience (Rosman et al., 2019). Practicing mock code team training with RCDP simulation allows for learning new skills through repetition. Learners can gain confidence, decrease anxiety, and experience learning in a safe environment (McPhee, 2018). Participants are introduced to new information in small chunks, improving information retention and preventing cognitive overload. RCDP simulation allows participants to practice their skills, debrief, reset, and replay repetitively, improving team performance in CPR (Ng et al., 2021). The literature review substantiates this project's goal to implement prepackaged RCDP mock code simulations for nurse educators or mock code instructors to improve team dynamics in responding and performing as a team in a mock code. Project Plan and Implementation 12 Intermountain Health Utah Valley ICU requires two mock code team trainings per year. Their team of mock code instructors will learn and utilize a new tool and mock code process called RCDP. Related to significant nursing turnover and variable experience, this team will utilize this method to build confidence in delivering CPR (Chancey et al., 2019) and improve team performance (Lemke et al., 2019). The plan and implementation process, interdisciplinary team, description of project deliverables, and timeline are further discussed in the following section. Plan and Implementation Process The prepackaged RCDP mock code curriculum and tool will be taught and passed off with ten Utah Valley ICU charge nurse mock code instructors. This group will be divided in half, with five mock code instructors attending one of two scheduled trainings and the other half attending the second training. The training will include the RCDP mock code process, concepts of the mini debrief, and practice time given utilizing the RCDP tool to support the standardized team training. The two-hour instructor training will occur in an empty Utah Valley ICU unit patient room. The prepackaged RCDP mock codes, toolkit, and equipment to support the training of all unit staff are housed in the same location on the unit for ease of setup and consistency in training. One hundred and forty caregivers will be signed up in nineteen groups of seven caregivers to participate in the RCDP mock code. The newly trained instructors will facilitate the training. Two instructors per session will set up the mock code team training and determine the roles of lead and co-lead, utilizing the RCDP tool designed for each role. Interdisciplinary Team 13 Two ICU unit educators contributed to the vision and development of this project. They already had a team of instructors in place who supported the implementation of required mock codes on their unit. They understood the benefits of RCDP and wanted to help their instructors learn and implement this method in their mock code practice. This team of instructors will be instrumental in utilizing the tool designed to support the scheduled pauses for the RCDP mock code. Their knowledge, understanding, and buy-in of this unique way to run a mock code are essential to this project's success. They will impact patient care and outcomes by practicing a mock code with early correction, positive learning, and improved skills (Lemke et al., 2019; San et al., 2021; Swinger et al., 2019). Description and Development of Project Deliverables The project's deliverables for the RCDP prepackaged mock codes included developing the instructor training curriculum PowerPoint presentation (see Appendix A). The PowerPoint covers information on additional deliverables created, such as the Utah Valley ICU Lead and Colead Instructor Guidance, the Situation, Background, Assessment, Recommendation, and roles, and the AHA Cardiac Arrest Algorithm RCDP Tool. The debriefing notes were created for the co-lead to manage the manikin setup, rhythm simulators, laminated code medication tray, laminated code sheet, and Zoll training pads for the Zoll Defibrillator (see Appendix A). The Rapid Cycle Deliberate Practice Prebrief Checklist was created to be reviewed and completed by the instructors before starting the mock code team training (see Appendix A). The lead and colead will conduct task training on the Zoll Defibrillator and introduce the participants to the rest of the equipment, including the manikin (see Appendix A). The lead and co-lead will choose whether to run a Vfib/pVT or Asystole/PEA algorithm. They will have the RCDP tools for their chosen cardiac arrest algorithm path (see Appendix A). This tool is prepackaged and 14 customizable for the nurse educator to write their Situation, Background, Assessment, and Recommendation tool and use the RCDP algorithm (see Appendix A). A pre-and post-knowledge survey (see Appendix B) will be conducted before and after the mock code training. The survey will assess the same questions pre- and post-evaluation to measure the level of impact before and after the mock code. The questions were created with the stakeholders based on critical information they would like to understand related to a standard mock code compared to an RCDP mock code. The survey will help them determine future best practices for mock codes. Timeline The mock code instructors will be trained in one of two sessions over two weeks. These two sessions will be scheduled for 2 hours. After the initial training, this timeframe will be evaluated to ensure enough time is allotted to cover the material and training. The training includes practicing the newly developed RCDP tool and running through each scenario, starting with task training and facilitating or co-facilitating each scenario. The lead and co-lead will practice their roles and how to approach debriefing together. The RCDP mock codes will be implemented in 19 sessions over two months. Staff evaluations will be reviewed after all 19 training sessions, and adjustments will be made to the RCDP mock code tool and process (Appendix C). Equipment, training folders, RCDP mock code tool, and evaluations will be delivered to Utah Valley ICU in preparation for the instructor training. The instructor training will begin in early March 2024, and then RCDP Mock Codes will be implemented and evaluated. Project Evaluation 15 This project's effectiveness will be evaluated using formative and summative methods with the caregivers attending RCDP mock code training. During the intermittent pauses and debriefing with RCDP mock codes for the formative approach, there will be time for questions and answers. This approach will give participants time to refocus their priorities and ask questions. For the summative approach, the participants will take pre- and post-knowledge surveys with a 5-point Likert scale (see Appendix B). They will complete the pre-knowledge survey right before participating in the RCDP mock code and then complete the post-knowledge survey after the mock code. Comparing the participants' pre- and post-surveys will give feedback on their confidence and knowledge by running a mock code and using the RCDP method. In addition, the surveys will also identify whether participants are more comfortable running a code blue after the training. Participants will be informed and encouraged to complete the pre- and post-surveys before and after the simulation training. They will be notified that the surveys and information they share are anonymous and confidential. The participant's leadership may access the roster names as attending the course for verification of training, but participant names are not associated with the surveys. The information gathered will be used to improve the training, develop ongoing data, and identify best practices. Ethical Considerations Henricksen et al. (2017) address psychological safety as a primary ethical consideration during the simulation pre-brief. Mock codes sometimes bring a personal or situational event with a patient, family member, friend, or other to the forefront that emotionally affects a participant. In some cases, an overwhelming feeling of anxiety and fear may take over, rendering the caregiver unable to move forward in the mock code practice. Pausing the mock 16 code and removing the caregiver from a psychologically unsafe experience is essential. Learning does not occur when someone feels psychologically unsafe. Working with the caregiver to determine alternate learning options will create a successful experience. A facilitator or educator can evaluate the participant and offer support and counseling services, such as the Employee Assistance Program. Another consideration is to make the participants aware in the pre-brief that RCDP has purposeful pauses. Chancey et al. (2019) found that the planned pauses give the caregivers time to debrief, ask questions, and have an opportunity to reset the scenario and replay the mock code blue algorithm, giving them more practice. At times, a caregiver will present with performance anxiety, and they identify a simulation scenario as a performance critique, therefore feeling unsafe. Caregivers must understand that they did nothing wrong when a pause happens and must be informed so they are prepared for them. Learners noted the positive impact of early error correction and decreased cognitive overload with frequent purposeful pauses. Discussion. This project will be disseminated through Intermountain Health Simulation leadership, as a poster presentation at conferences and meetings, and with faculty and peers of Weber State University. It can benefit nursing by standardizing practice, fostering clinical performance, and improving nursing actions in a code blue. Project dissemination, significance, implications, recommendations, and conclusion are further discussed in this section. Evidence-based Solutions for Dissemination This project was shared with Intermountain Health Nursing Excellence with the PowerPoint presentation of this project. This team has invited me to create a poster presentation to disseminate this project at the Intermountain Health Nursing Research and Evidence-Based 17 Practice Symposium and at the Western Institute of Nursing (WIN) conferences held in April 2024. I will also present my project poster to my peers and faculty at Weber State University on April 16, 2024. Additionally, as a Sigma Theta Tau Nu Nu Chapter member, I will present my project poster at the Induction and Annual Meeting to showcase projects in March 2024. This project will continue to develop with opportunities to become a podium presentation and publication. Clinical implementation of this project tool has been presented to the Intermountain Simulation Consortium and approved for dissemination to simulation consultants. The simulation consultants will use this as a tool for RCDP mock code requests and systemimplemented RCDP mock codes. It is a companion tool to support facilitators and educators for RCDP mock codes with AHA 2020 Cardiac Arrest algorithms. Significance to Advance Nursing Practice This project can benefit the nursing profession by helping to standardize and improve nursing actions in a code blue with the practice of the RCDP tool prior to the arrival of the hospital-wide code team (San et al., 2021). Readily available equipment that gives CPR feedback and a high-fidelity experience using a low-fidelity manikin, even a torso manikin, can add value and more accessibility to this essential team training (Cheng et al., 2020). RCDP resuscitation training provides a spaced learning approach that improves clinical performance and technical skills. It offers a safe and less distracting training environment for the nursing team. The RCDP method helps hospitals discover the strengths and weaknesses of current nursing teams and customize the mock code experience to add real-time practice for the identified gaps and reinforce the team's strengths (Cheng et al., 2020; San et al., 2021). Implications 18 The identified strength of this project is the overall benefit RCDP resuscitation training can provide to the individual nurse's learning and the nursing team. The RCDP method requires access to educational equipment commonly available at each hospital. The return on investment for this high-stakes, low-volume essential training can demonstrate improved patient care and patient outcomes as measured in code blue metrics. Nursing feedback can be evaluated through post-simulation training surveys. Additionally, the RCDP tool can be easily updated to meet the AHA Cardiac Arrest algorithms as they continue to update and change. The limitations identified with this project are the adoption of this method of resuscitation training with individual teams, the backing of nursing education leaders, and system healthcare leaders who make decisions about code blue training. In addition, access to the curriculum, the educational tools needed to run an RCDP mock code, and a mentor to assist with the tool until competency and comfort level with the tool and method are achieved were also identified. The RCDP tool is housed in Intermountain Health Simulation. Obstacles can be reduced since each simulation consultant has access to the standardized tool and has been trained to use it. The consultant will provide a tool and be the designated mentor in training the educator/facilitator on the use and implementation of the tool. This project will support the nurse and nurse educator with a standardized EBP tool to implement RCDP mock codes on nursing units. This method supports individual nurse educators and the nursing profession in developing standardized tools for mock codes, mentoring them with the new process to ensure training and implementation of the new tools and RCDP method. Recommendations 19 This project has continued to adjust and improve based on faculty, peers, and content expert recommendations. As it is implemented as a system project, follow-up with simulation consultants will identify gaps that need further research, adjustments, and improvements to the RCDP mock code tool. No gaps are identified at this time. Conclusions RCDP promotes early error correction in a safe and positive learning environment. With RCDP mock code practice, the AHA 2020 guidelines can be met by time to defibrillation being within two minutes of a shockable rhythm or epinephrine delivered as soon as possible with a non-shockable rhythm. Patients can receive optimal treatment and the best possible chance of survival. 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Implementation science: Application of evidence‐based practice models to improve healthcare quality. Worldviews on Evidence-Based Nursing, 18(2), 76–84. https://doi.org/10.1111/wvn.12495 25 Appendix A PowerPoint for Utah Valley ICU Lead and Co-Lead Instructor Guidance and Engagement 26 27 28 29 30 31 32 33 34 35 36 37 38 39 Appendix B Pre-and Post-Survey Questions 1. Mock code blue team training has made me confident in my role in a code blue. 1 – Strongly Disagree 2- Disagree 3 – Neutral 4 – Agree 5 – Strongly Agree 2. I know my resources (i.e., AHA ACLS Cardiac Arrest Algorithms) and use them in mock code blue training. 1 – Strongly Disagree 2- Disagree 3 – Neutral 4 – Agree 5 – Strongly Agree 3. I am confident in my ability to set up, operate, and read feedback on the Zoll defibrillator. 1 – Strongly Disagree 2- Disagree 3 – Neutral 4 – Agree 5 – Strongly Agree 4. I understand the functions of the crash cart meds for a code blue and how to administer them. 1 – Strongly Disagree 2- Disagree 3 – Neutral 4 – Agree 5 – Strongly Agree 5. Rapid Cycle Deliberate Practice (RCDP) has improved my response and understanding of my role in a mock code. Strongly Disagree 2- Disagree 3 – Neutral 4 – Agree 5 – Strongly Agree 6. How long have you been practicing as an RN overall? 1-2 years 3-5 years 6-10 years 11-20 years Greater than 20 years 40 Appendix C Timeline