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responses (agree or strongly agree) from pre-intervention to post-intervention results. The first survey question was designed to provide insight into the nurses’ general confidence level for code blue situations, the results of which can be seen in Figure 1 below. Of the 163 responses to the pre-intervention survey, 60.7% of nurses indicated a positive response. Post-intervention results demonstrated 81.8% positive responses, with no negative responses (disagree or strongly disagree) reported. CODE BLUE: DO YOU KNOW WHAT TO DO? 14 Figure 1. Survey Question 1: “I feel confident in and prepared for a code blue situation.” The collective results of the post-intervention survey revealed that 97% of nurses expressed confidence in calling and recognizing a code blue, 94% were confident in performing high-quality CPR, and 90.9% were confident in administering oxygen via a bag-valve-mask. 72.7% of nurses reported confidence in monitoring vital signs and heart rhythms and 78.8% felt confidence in operating the Zoll defibrillator during a code blue situation. Overall, qualitative feedback was positive from the nurses who participated in the training. 28 survey participants indicated that they would like to participate in mock code simulation on a more regular basis. The results of this project are limited due to lack of postintervention survey responses, however the data collected thus far indicates that the project was successful in increasing nurse confidence and readiness for a code blue situation. Discussion At the culmination of this project, the mock code simulations were well received by the hospital administration and nursing staff. Nurses who participated in the training were eager and CODE BLUE: DO YOU KNOW WHAT TO DO? 15 appreciative of the opportunity to practice code blue protocols and skills. One highlight of the training was the opportunity to interact with the Zoll defibrillator, as many nurses stated they had never had hands-on practice before. During the training, special attention was placed on the importance of teamwork and communication during a code blue situation. Several areas of improvement were identified for future implementation of the mock code simulation. Nurses who completed the training and post-intervention survey requested further training for how to document during a code blue and how to analyze heart rhythms. However, hospital protocol indicates that these are not skills performed by BLS-certified medical-surgical nurses, and therefore were omitted from the training. Less than 80% of nurses reported confidence in operating the Zoll defibrillator in the post-intervention survey. It is recommended that future implementation prioritizes defibrillation as a key competency to master. One of the limitations of this project was low participation in the post-intervention survey. This presented a challenge in determining the success of the project as the smaller sample size may affect the accuracy of the results. Further, training participation was limited due to time constraints and lack of availability of nursing staff. For this reason, future implementation should provide for scheduled training times so that all nursing staff could participate in the full simulation. It is recommended that a post-simulation debriefing session be incorporated to allow for self and team reflection on performance. Preliminary results indicate that the mock code simulation is effective in improving nurse confidence and readiness for a code blue. Therefore, it is recommended that the mock code simulation be conducted on a quarterly basis to maintain nurse competence in the skills and information presented. Conclusion Code blue situations, while rare, are the most frightening situations that a healthcare CODE BLUE: DO YOU KNOW WHAT TO DO? 16 professional can encounter. With basic life support certification required on a biannual basis, it is necessary for hospitals to provide code blue training more frequently to maintain nurse preparedness. Evidence suggests that in-situ mock code simulation is evidence-based practice to provide the most realistic and effective code blue training. This quality improvement project aimed to determine if mock code simulation would increase nurse confidence and readiness for a code blue situation. The results of this project showed significant improvement in overall nurse confidence, and recommendations were made to maintain the training on a quarterly basis. With no associated and considerable potential positive impact on patient outcomes and nurse confidence, it is clear that this quality improvement project was successful in achieving the project aim. CODE BLUE: DO YOU KNOW WHAT TO DO? 17 References American Heart Association. (2010). 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care science. Lippincott Williams & Wilkins. Code of Ethics PDF. (2021). ANA. https://www.nursingworld.org/coe-view-only Delac, K., Blazier, D., Daniel, L., & N-Wilfong, D. (2013). Five alive: using mock code simulation to improve responder performance during the first 5 minutes of a code. Critical Care Nursing Quarterly, 36(2), 244–250. https://doi.org/10.1097/cnq.0b013e3182846f1a Eroglu, S. E., Onur, O., Urgan, O., Denizbasi, A., & Akoglu, H. (2014) Code Blue Policy for a Tertiary Care Trauma Hospital in India 1 

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