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Future recommendations are to expand the project and use the standard algorithm in other areas across the hospital and healthcare system. 

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- Code blue documentation logs and EMR documentation to compare code events.
- Code blue documentation sheets are duplicate sheets and manual logging is crucial until the implementation of a new EMR system next summer.
- Measures of initiation of PPV, chest compressions, and medication administration are collected to determine deviation from NRP guidelines.

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Intervention and Implementation:
- Simulated code blue events to improve documentation and to assist with code blue review
- Formation of an interdisciplinary neonatal code blue review team. This provides the opportunity for all disciplines to take back appropriate improvement techniques to their respective teams (Reed et al., 2017).
- Requires participation from all members of the interdisciplinary team including MD, Pharmacy, RN, and RT.
- Team will meet at predetermined intervals and review all simulated and actual code events for the prior timeframe.
- Formalized algorithm related to Neonatal Resuscitation Program to determine deviations from standards such as initiation of CPR, med administration, and airway management. This facilitates open discussion that promotes process improvement.
- Identified deviations will be reviewed with NICU team members via regular staff meetings, guided educational topics and competencies, remedial education (as needed), electronic communication such as weekly huddle notes, staff emails, and through continued simulation activities that integrate the deviations for identification.
- Review findings will be shared and disseminated in hospital committees such as performance improvement and NICU Steering. System wide meetings such as Code Blue and Critical Care will also review findings.

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This project utilizes the PDSA model of change. The PDSA model promotes the creation of a specific change, testing the new change in practice, and to interpret the results to determine effectiveness.

This model promotes real work and process changes that benefit clinical practice with an identified improvement. Appropriate measures and potential outcomes guide the intervention and implementation phases of the project.

Building a strong team and identifying goals and objectives starts the project off in the appropriate direction.

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Regulatory Standards:
- The Joint Commission issued new standards starting 2022 for specific in hospital resuscitation event review, analysis, and data collection.
- American Heart Association and Neonatal Resuscitation Program guide practice during resuscitation events.
- American Heart Association developed Get with the Guidelines that promotes interdisciplinary adherence and collaboration during resuscitation events.

Deviation in Resuscitation Standards
- Approx. 5-7% of neonates receive resuscitation support (Halling et al., 2021).
- 17% of resuscitation events include one area of deviation from set resuscitation standards (Wolfe et al., 2020).
- When code events are videotaped and replayed, only 16% of events adhered correctly to standards (Maya-Enero et al., 2018).
- Outcomes are drastically decreased when proper adherence to standards are not met. Mortality increases and the ROSC decreases with deviation.

Simulation as a Learning Strategy
- The use of simulated code events help transfer knowledge into tangible skills and practices (Gurung et al., 2020).
- Vail et al. (2018) conducted a study that over time saw an improvement in initiation of critical interventions during resuscitation events.
- Many institutions identify opportunities with their code blue processes during simulation events (Reed et al., 2017).
- Simulation enhances team work and communication skills between coworkers.

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In the neonatal population, does the formation of an interdisciplinary review team promote adherence to the Neonatal Resuscitation Program standards and improve patient outcomes post code blue event?

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Currently within the NICU, there is no formal code blue review team. Code blue review and analysis are essential to improving outcomes for neonates. 