Performance Manager
Staff Perceptions Needs Assessment Re: Resuscitation of Adult Patient in Med-Surg
Participation Consent  
  Participation in this anonymous survey provides us with your consent. Yes- continue survey
No- donít continue survey
I: DEMOGRAPHICS  
  Discipline :(check one) Attending
Intern
Resident
Registered Nurse
Critical care Nurse
Advanced Practice RN
Physician Assistant
Respiratory Therapy
Pharmacist
Anesthesiologist
Other
  Acute care experience :(check one) 1-5 years
6-10 years
11-15 years
16-20 years
21 or more years
  Age: 20 to 29
30 to 39
40 to 49
50 to 59
60 +
  Sex: Male
Female
  Education Level: education level Associates
education level Bachelors
education level Masters
education level PhD
education level MD
education level Other
  Have you had any critical care experience? Yes
No
  Years at BIDMC (check one): 1-5 years
6-10 years
11-15 years
16-20 years
21 or more years
  Current work area (check one) Inpatient
Outpatient
  What CPR Training/Certification have you had?  
 
BLS
Yes No
 
ACLS
Yes No
 
PALS
Yes No
 
NRP
Yes No
  Online Code Competency Yes No
  Simulation Center Mock Code Yes No
  Code Blue Lectures in RN Orientation Yes No
  Community/ First Aid CPR Yes No
II. CODE EXPERIENCE 1. Have you actively participated in a code situation? Yes
No
   
  2.) How many codes have you actively participated in your career (check one): none
1-5 codes
6-10 codes
11-15 codes
16 or greater codes
  3.) While at BIDMC, how many codes have you actively participated in that involved the adult, med-surg patient (check one): none
1-5 codes
6-10 codes
11-15 codes
16 or greater codes
III: PERCEPTION OF TEAM  
  1.) Of the adult med-surg codes you have participated in at BIDMC, how often was a leader identified (select number that reflects your answer)? 0 Never
1
2
3 Occasionally
4
5 Sometimes
6
7
8 Often
9
10 Always
  2.)In your most recent adult med/surg code experience at BIDMC, that you participated in, or observed, what was the manner in which the leader was identified (select one):  
  I assumed it was the physician. Yes No
  Orange Team Lanyard Yes No
  Position at head/foot of bed Yes No
  Verbalization Yes No
  3.) In your Med-Surg code experiences at BIDMC how often did a post-arrest debrief occur? (select number that reflects your answer): 0 Never
1
2
3 Occasionally
4
5 Sometimes
6
7
8 Often
9
10 Always
  4.) Who conducted the debriefing? (choose one): Nurse Manager
Clinical Nurse Specialist
Unit Based Educator
Administrative Clinical Supervisor
Quality Assurance Director
Division Clinician
An Attending Physician
Department Chair
  5.) Who would be the first person you would consult with if you had a concern? (choose one): Nurse Manager
Clinical Nurse Specialist
Unit Based Educator
Administrative Clinical Supervisor
Quality Assurance Director
Division Clinician
An Attending Physician
Department Chair
  6.) In your BIDMC Med-Surg code experiences, how often did team members demonstrate effective communication skills(select number that reflects your answer): 0 Never
1 Sometimes
2 Frequently
3 Often
4 Always
  7.) In your BIDMC Med-Surg code experiences, how often did team members demonstrate effective teamwork skills (select number that reflects your answer): 0 Never
1 Sometimes
2 Frequently
3 Often
4 Always
  8.) In your BIDMC Med-Surg code experiences, which of the following behaviors have you observed?  
  Team Leader debriefed Group Yes No
  Team Leader verbalized the treatment plan Yes No
  Team members asked each other for help Yes No
  Team members communicated respectfully using names and appropriate tone of voice. Yes No
  Team leader was receptive to new ideas Yes No
  Team Members repeated tasks assigned (e.g. IV EPI 1MG given) Yes No
IV: ROLE ASSIGNMENT  
  1.)Which of the following roles have you performed?  
 
Chest Compressor
Yes No
 
Ventilator
Yes No
 
Team Leader
Yes No
 
Medication Delivery(intubation meds)
Yes No
  Medication preparation (intubation) Yes No
 
Medication Delivery(cardiac arrest meds)
Yes No
 
Medication Preparation (Cardiac Meds)
Yes No
 
Airway Management/Specialist
Yes No
 
Code Cart Management
Yes No
 
Defibrillator
Yes No
 
Event Recorder/Documentor
Yes No
 
IV Access
Yes No
  2.) In your BIDMC Med-Surg code experiences, how often was your role clear? (select number that reflects your answer) 0 Never
1
2
3 Occasionally
4
5 Sometimes
6
7
8 Often
9
10 Always
  3.) How did you know what your role was (check one): The code leader assigned my role
My role was self-assigned
Other
  4.) How often were the roles of each of the team members made clear? (select number that reflects your answer) 0 Never
1
2
3 Occasionally
4
5 Sometimes
6
7
8 Often
9
10 Always
V-Task associated w/role 1.)What is your perception of who should be performing these roles (which discipline) (please check one per role )  
  Role 1: Team Leader A. Physician
B. Clinical RN
C. Critical Care RN
D. Pharmacist
E. Anesthesiologist
F. Code Leader
G. Respitatory Therapist
H. PCT
 
Role 2: Interpretation of code algorithms
A. Physician
B. Clinical RN
C. Critical Care RN
D. Pharmacist
E. Anesthesiologist
F. Code Leader
G. Respitatory Therapist
H. PCT
 
Role 3: Cardiac medication preparation
A. Physician
B. Clinical RN
C. Critical Care RN
D. Pharmacist
E. Anesthesiologist
F. Code Leader
G. Respitatory Therapist
H. PCT
 
Role 4: Cardiac medication administration
A. Physician
B. Clinical RN
C. Critical Care RN
D. Pharmacist
E. Anesthesiologist
F. Code Leader
G. Respitatory Therapist
H. PCT
 
Role 5: Intubation med (preparation)
A. Physician
B. Clinical RN
C. Critical Care RN
D. Pharmacist
E. Anesthesiologist
F. Code Leader
G. Respitatory Therapist
H. PCT
 
Role 6: Intubation med administration
A. Physician
B. Clinical RN
C. Critical Care RN
D. Pharmacist
E. Anesthesiologist
F. Code Leader
G. Respitatory Therapist
H. PCT
 
Role 7: Defibrillator
A. Physician
B. Clinical RN
C. Critical Care RN
D. Pharmacist
E. Anesthesiologist
F. Code Leader
G. Respitatory Therapist
H. PCT
 
Role 8: Compressor
A. Physician
B. Clinical RN
C. Critical Care RN
D. Pharmacist
E. Anesthesiologist
F. Code Leader
G. Respitatory Therapist
H. PCT
 
Role 9: Ventillator
A. Physician
B. Clinical RN
C. Critical Care RN
D. Pharmacist
E. Anesthesiologist
F. Code Leader
G. Respitatory Therapist
H. PCT
 
Role 10: Preparation of laryngoscope/ ET tube for intubation
A. Physician
B. Clinical RN
C. Critical Care RN
D. Pharmacist
E. Anesthesiologist
F. Code Leader
G. Respitatory Therapist
H. PCT
 
Role 11: Perform intubation
A. Physician
B. Clinical RN
C. Critical Care RN
D. Pharmacist
E. Anesthesiologist
F. Code Leader
G. Respitatory Therapist
H. PCT
 
Role 12: Code Cart Management
A. Physician
B. Clinical RN
C. Critical Care RN
D. Pharmacist
E. Anesthesiologist
F. Code Leader
G. Respitatory Therapist
H. PCT
 
Role 13: IV access
A. Physician
B. Clinical RN
C. Critical Care RN
D. Pharmacist
E. Anesthesiologist
F. Code Leader
G. Respitatory Therapist
H. PCT
 
Role 14: Event Recorder/ Documentor
A. Physician
B. Clinical RN
C. Critical Care RN
D. Pharmacist
E. Anesthesiologist
F. Code Leader
G. Respitatory Therapist
H. PCT
 
Role 15: Alert / update family re: change in status
A. Physician
B. Clinical RN
C. Critical Care RN
D. Pharmacist
E. Anesthesiologist
F. Code Leader
G. Respitatory Therapist
H. PCT
 
Role 16: Support patient family/ significant others
A. Physician
B. Clinical RN
C. Critical Care RN
D. Pharmacist
E. Anesthesiologist
F. Code Leader
G. Respitatory Therapist
H. PCT
 
Role 17: Managing crowd control
A. Physician
B. Clinical RN
C. Critical Care RN
D. Pharmacist
E. Anesthesiologist
F. Code Leader
G. Respitatory Therapist
H. PCT
VI: Perception of comfort  
  1.) What is your level of comfort for the following code team roles :(please select one answer)  
 
Team Leader
0 Not at all Comfortable
1
2
3
4
5
6
7
8
9
10 Very Comfortable
 
Delegation of tasks to team
0 Not at all Comfortable
1
2
3
4
5
6
7
8
9
10 Very Comfortable
 
Interpreting code algorithms
0 Not at all Comfortable
1
2
3
4
5
6
7
8
9
10 Very Comfortable
 
Use of defibrillator and application of AED
0 Not at all Comfortable
1
2
3
4
5
6
7
8
9
10 Very Comfortable
 
Prepare emergency cardiac medications
0 Not at all Comfortable
1
2
3
4
5
6
7
8
9
10 Very Comfortable
 
Administer emergency cardiac medications
0 Not at all Comfortable
1
2
3
4
5
6
7
8
9
10 Very Comfortable
 
Prepare medications for intubation
0 Not at all Comfortable
1
2
3
4
5
6
7
8
9
10 Very Comfortable
 
Administer medications for intubation
0 Not at all Comfortable
1
2
3
4
5
6
7
8
9
10 Very Comfortable
 
Ventillator
0 Not at all Comfortable
1
2
3
4
5
6
7
8
9
10 Very Comfortable
 
Compressor
0 Not at all Comfortable
1
2
3
4
5
6
7
8
9
10 Very Comfortable
 
Managing crowd control
0 Not at all Comfortable
1
2
3
4
5
6
7
8
9
10 Very Comfortable
 
Speak up about code status
0 Not at all Comfortable
1
2
3
4
5
6
7
8
9
10 Very Comfortable
 
Speak up about family presence
0 Not at all Comfortable
1
2
3
4
5
6
7
8
9
10 Very Comfortable
 
Debriefing staff
0 Not at all Comfortable
1
2
3
4
5
6
7
8
9
10 Very Comfortable
 
Support of patient family/ significant others
0 Not at all Comfortable
1
2
3
4
5
6
7
8
9
10 Very Comfortable
 
Documentation of code
0 Not at all Comfortable
1
2
3
4
5
6
7
8
9
10 Very Comfortable
   
  2.) What is your overall comfort/ confidence level in codes? (select number that reflects your answer): 0 Not at all Confident
1
2
3
4
5
6
7
8
9
10 Very Confident
VII: CODE TRAINING & EDU  
  1.) Have you completed the online code compentency? Yes
No
  2.) If yes, how helpful did you find this? (select number that reflects your answer): 0 Not at all helpful
1
2
3
4
5
6
7
8
9
10 Helpful
  3.) If you did not find the online competency helpful, why not?
  4.) Have you participated in a mock code in the BIDMC Simulation Center? Yes
No
  5.) If yes, how helpful did you find this? (select number that reflects your answer): 0 Not at all helpful
1
2
3
4
5
6
7
8
9
10 Helpful
  6.) If you did not find the mock code helpful, why not?
  7.) As a member of the Code Team (who carries the code pager), did you receive any official code training? Yes
No
N/A
  8.) Which learning opportunitites could BIDMC offer you to improve your confidence and skills in codes? (please select all of those that would be the most meaningful):  
  Online Training/webinar
  Unit based mock codes
  Simulation as team
  Lectures
  Case Studies
  Simulation to practice skills only
  Training as a team
          



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