The high risk and low volume of medical emergencies, combined with long periods between training sessions, on 2 progressive care units at Mayo Clinic, Rochester, Minnesota, established the importance of transforming how nursing staff are trained to respond to medical emergencies.


To increase confidence levels and improve nursing performance during medical emergencies via in situ simulation.


An in situ, mock code quality improvement program was developed and implemented to increase nurses’ confidence while improving nursing performance when responding to medical emergencies. For 2 years, each unit conducted mock codes and collected data related to confidence levels and response times based on the recommendations in the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.


In those 2 years, nursing staff response times for calling for help improved 12%, time elapsed before initiating compressions improved 52%, and time to initial defibrillation improved 37%. Additionally, staff showed an increase in perceived confidence levels. Staff reported their appreciation of the opportunity for hands-on practice with the equipment, reinforcing their knowledge and refining their medical emergency skills.


In situ mock codes significantly improve response times and increase staff confidence levels. In situ mock codes are a quick and efficient way to provide hands-on practice and allow staff to work as a team.

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