Use of a defined role/responsibility chart and a color coded floor code map as an innovative tool to improve role clarity during in-situ simulations

1. Use Of A Defined Role/Responsibility
Chart And A Color-Coded Floor Code
Map As An Innovative Tool To Improve
Role Clarity During In-Situ Simulations
Mona Khattab, MD, Nathan Sundgren, MD,
Leigh Ann Cates, PhD, APRN, NNP-BC, Kellie Kainer,
RN, Leisa McMullen, BSN, MS, Joseph Hagan, and
Jennifer Arnold, MD, MSc.
Baylor College of Medicine, Texas Children's Hospital, Houston, Texas USA
INSPIRE @ IMSH 2017 – Orlando, FL, USA
International Network for Simulation-based Pediatric Innovation, Research and Education

2. • The simulation center at Texas Children's Hospital is
expanding a Comprehensive In Situ Simulation
Program to the neonatal ICU (NICU)
• Through a needs assessment survey, role clarity and
effective communication during codes were identified
as crucial areas for improvement.
• There is little research related to the appropriate roles
and positions for effective management of a neonatal
resuscitation.
• Little is known about the optimal positioning of the
infant for a neonatal resuscitation in the NICU.
International Network for Simulation-based Pediatric Innovation, Research and Education
Background

3. • Population: all NICU faculty & staff
• Interventions: 1. A “Roles and Responsibilities”
chart for each team member role 2. Patient
positioning during a code; head at foot of bed vs. side
of the bed
• Control/Comparison: 1. Routine codes with no floor
code map. 2. head at foot of bed vs. side of the bed
• Outcome(s): 1. Improve role clarity during a code
2. minimize multi-tasking and optimize perceptions of
workload. 3. Decrease mental, physical demand and
frustration during a code
International Network for Simulation-based Pediatric Innovation, Research and Education
PICO / Research Question

4. Utilizing a modified Delphi methodology our team:
1. Performed a close inspection of the NICU layout and
equipment
2. Designed a color-coded floor code map that can be
easily and optimally integrated into the existing NICU
environment
3. Created a “Roles and Responsibilities” chart for each
team member role typically involved in a code
4. Implemented high fidelity multidisciplinary simulations
to evaluate potential roles and positions
5. Focused debriefings
6. NASA-TLX to evaluate mental, physical, and
temporal demands, effort, and frustration within the
roles and responsibilities as well as their physical
location on the floor map.
International Network for Simulation-based Pediatric Innovation, Research and Education
Approach / Design

5. • ALERT Presentation: January 2017
• IRB Submission: Revision in progress
• Recruitment / Data Collection: Nov 2016-March 2017
• Data Analysis: April 2017
• Abstract Presentation: IMSH 2018 IPSSW 2018
• Manuscript Preparation: June 2018
International Network for Simulation-based Pediatric Innovation, Research and Education
Timeline

6. 1. Other ideas for evaluating role clarity?
2. Other assessment tools for infant position during a
code and for the floor code map?
3. Collaborators from other NICUs?
International Network for Simulation-based Pediatric Innovation, Research and Education
3 questions to improve
study

7. At INSPIRE @ IMSH 2017:
Obtain expert opinion/ suggestions for
study improvement
International Network for Simulation-based Pediatric Innovation, Research and Education
Goals to accomplish

8. Name: Mona Khattab, MD
Institution: Baylor College of Medicine
E-mail, Phone: khattab@bcm.edu
International Network for Simulation-based Pediatric Innovation, Research and Education
Contact Information