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outcomes is considerable. This project was planned and implemented by University of San Francisco student nurses, and therefore had no personnel costs. The equipment used during the training sessions included CPR mannequins, Zoll defibrillator, Zoll One-step pads, and bag-valve-mask ventilation equipment. All equipment was previously utilized for other training programs, and therefore no supplies needed to be purchased. The training sessions were provided during regularly scheduled nursing shifts and led by nursing students; therefore, additional staff compensation was not a necessary cost. While the initial project was implemented at no cost to the hospital, the recommendation is to continue the mock code simulations on a quarterly basis. This would require a nurse educator to implement the training as well as updated equipment due to expected wear-and-tear. With no current associated costs, and clear benefits to patient outcomes, it is clear that this project is feasible and the mock code simulations should be implemented on a quarterly basis. Intervention This quality improvement project was implemented over a period of fourteen weeks, which was tracked in a Gantt chart to monitor progress (see Appendix D). An initial survey was conducted among the nurses and nursing assistants throughout the four medical-surgical units to assess confidence and readiness for a code blue (see Appendix E). This survey utilized a Likert scale as well as short answer questions to collect quantitative and qualitative data on the effectiveness of mock code simulations. Following the initial survey period, several educational objectives were identified including an emphasis on high-quality CPR, hands-on practice with the Zoll defibrillator, and the importance of communication. A lesson plan was developed to guide the mock code simulations and ensure that all educational objectives were met (see CODE BLUE: DO YOU KNOW WHAT TO DO? 12 Appendix F). This lesson plan allowed for standardized training sessions and ensured that information provided aligned with AHA and hospital guidelines for code blue interventions. The implementation of the mock code simulations took place over the course of three weeks in which three nursing students would provide brief training opportunities on each of the four units. Training sessions were scheduled for day, evening, and night shift and avoided occupied working hours such as medication administration times, shift change, and mealtimes. Nurses and nursing assistants participated in the simulations in groups of 3-5 per session. The simulations were hands-on and interactive, requiring the nurses to act quickly and communicate their actions with the team. This placed an emphasis on communication and teamwork as central to a successful code blue response. Nurses were able to participate in the training as many times as they preferred. After the three-week implementation period, the same survey was presented to the nurses who participated in the simulation (see Appendix E). This would identify data changes related to the training and eliminate extraneous survey responses. Measures The success of the project could be evaluated in two ways, primarily through selfreported confidence levels obtained through the pre- and post-survey. A more indirect measure of success is patient survival rates and code blue data analysis as listed in Appendix C. Due to the time constraints and a lack of code blue events during the project duration, patient code blue data were not achievable. This project applied the Plan-Do-Study-Act (PDSA) cycle to monitor performance and to guide discussion of changes to be made prior to the next implementation cycle (see Appendix G). The “Plan” step involved the assessment of current nurse code blue confidence as well as the identification of skills which needed improvement. The “Do” step involved the implementation CODE BLUE: DO YOU KNOW WHAT TO DO? 13 of the mock code simulations on the medical-surgical units. The “Study” step referred to monitoring nurse participation, identifying strengths and weaknesses of the lesson plan, and reassessing nurse code blue confidence. The “Act” step was dependent on the success of the training to identify effective strategies, make adjustments as needed, and integrate the training program into other units. Ethical Considerations The American Nurses Association Code of Ethics emphasizes that ethical nursing practice requires a commitment to advancing the profession through research and scholarly inquiry (Code of Ethics PDF, 2021). The purpose of this quality improvement project is to maintain practice standards through education and simulation, thus ensuring nurse competency for code blue situations. This project has been approved as a quality improvement project by the faculty using quality improvement review guidelines and does not require IRB approval. Results The mock code simulations were conducted at various times throughout a three-week period. During this time, 111 nurses and 14 certified nursing assistants participated in the simulations. Results to the post-intervention survey were limited, however the data gathered shows a significant improvement in nurse confidence and readiness for a code blue situation. Of the 10 survey questions posed, seven showed significant increases in positive 

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