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Publication Date



2021 prov rn ca; 2021 prov rn poster; california, phcmc




Background: Delayed recognition of in-hospital cardiac arrest (IHCA) events can affect survival rates. At the project site, there was a failure to rescue in the medical-surgical population. Key elements of success include staff identifying at-risk patients combined with early interventions to prevent deterioration of cardiac arrest. Survival and favorable outcomes for IHCA (i.e., neurological sequelae) were shown to be highly dependent on several factors, such as a skilled resuscitation team, prompt initiation of cardiopulmonary resuscitation and defibrillation, and organizational structures to support resuscitation care; therefore, nurses are an integral part of an IHCA response.

Purpose / Aims: The purpose of this quantitative quasi-experimental quality improvement project was to determine if the implementation of Banks and Trull's code blue nurse champion role (CBNCR) would impact the nurses' knowledge and self-efficacy regarding cardiopulmonary resuscitation and patient IHCA survival rates at an acute care hospital in Southern California over four weeks. Bandura's self efficacy theory and the trans-theoretical model were theoretical underpinnings of the project.

Methods / Approach: A quantitative methodology was selected for this project to discover through statistical analysis, quantifiable, objective data related to the implementation of CBNCR on nurses' self efficacy to respond to cardiac arrest and survival of patients suffering IHCA before and after the intervention. The training for the CBNCR included IHI rapid response education and in-situ simulation on cardiac arrest scenarios. Results: Data on nurses' (N=18) cardiac arrest knowledge and self-efficacy were evaluated using the Knowledge and Attitude of Nurses in the Event of a Cardiopulmonary Arrest instrument. A paired t-test showed no statistically significant improvement in nurses' knowledge (p=.959) and self-efficacy (p=.910). The total patient population was 302, n=147 in the comparative (n=2 IHCA) and n=155 (n=1 IHCA). To analyze IHCA, a Fischer's exact test was used, which was not statistically significant (p=.667) (pre n=2, 50%; post n=1, 100%).

Discussion: Results indicated the CBNCRs may not improve nurses' knowledge and self-efficacy or IHCA rates. Although not statistically significant, clinical significance was demonstrated as the CBNCRs provided skills to improve early recognition of impending IHCA and enhanced nursing staff's awareness of patient's deterioration.

Conclusion: Simulation offers acute care nurses an opportunity to practice life-saving techniques in the clinical setting without patient harm. Simulation as a safety strategy focuses on developing positive attributes and productive capacities that underpin safety performance. Implementing dedicated nurse champions is a novel approach to improve recognition and response to deteriorating patients. Providing additional hands-on experience through cardiac arrest in-situ simulation could equip them to provide timely and effective CPR during cardiac arrest.

Implications for practice: The results provide insight into the innovative role of code blue nurse champions. Implementation of the CBNCR is predicated on providing educational training to a core group of medical-surgical nurses on rapid response roles, how to activate RRT, development of SBAR communication, and in-situ simulation on cardiac arrest. The recommendation for practice is to replicate and implement nurse CBNCRs throughout the medical-surgical units. Creating a hospital-wide CBNCR position may decrease nurses' anxiety, while increasing self-confidence and self-efficacy in recognizing patient deterioration and early initiation of CPR.

Clinical Institute

Cardiovascular (Heart)





Conference / Event Name

2021 Providence RN Conference


Virtual Conference

The Impact of the Implementation of Code-Blue Nurse Champions for Cardiac Arrest

Included in

Nursing Commons