Setup and Execution Of the Blindfolded Code Training Exercise

Communication errors are the leading cause of preventable patient harm in all of medicine. The blindfolded code training technique was designed to improve closed-loop communication and improve critical thinking in high-acuity situations. The main advantage of this teaching technique is that it teaches resident physicians effective communication and leadership strategies in a high-acuity situation without requiring any special equipment.

Before beginning the blindfolded code training exercise, gather all of the necessary supplies and materials and place the human patient simulator on an Emergency Department bed. Turn on the simulator and connect the simulator to the wireless network. Provide a seat five feet away from the foot of the bed and a blindfold for the code team leader.

Then seat the team leader facing away from the team. Print code resuscitation simulation scenarios for the faculty and upload any necessary radiographic images and electrocardiograms for each patient scenario. Before beginning the exercise, review the rules with the learners and have the team leader put on the blindfold.

Have the resuscitation team members verbally introduce themselves by role, name and position in relation to the patient in the bed to the blindfolded code team leader. I'm Patrick, I'm the med student, and I'm at the patient's right of the bed. I'm Edgar, I'm the emergency medicine resident, and I'll be at the head of the bed.

I'm Pat, I'm your nurse, I'm at the patient's left side of the bed and can administer medications. I'm Kate, I'm your senior resident, I'm at the left of the bed. When all of the team members have introduced themselves, read the stem for the case scenario to the code team leader and change the patient vitals and cardiac rhythms in alignment with the case scenario outline.

Then run the case scenario for eight to 10 minutes. Hi everyone, my name is Lauren. I'll be your team leader.

Please repeat all orders back in a closed-loop fashion. Does everyone understand? Yes.All right, Edgar, what does our patient look like?

So it's a middle-aged man. He's unresponsive and has no respiratory effort. Okay, what rhythm do I see on the monitor?

You see a Y complex, irregular rhythm, without discernible P, QRS, or T waves. Okay, that sounds like V-fib. Pat, do you feel a pulse?

I do not. Okay, Kate, please start chest compressions. Starting chest compressions.

All right, Patrick, please charge our defibrillator up to 200 joules. Turning on and charging the defibrillator to 200 joules. Okay, Edgar, please start bagging our patient at a rate of two breaths for every 30 compressions.

All right, I'll start bagging the patient two breaths for every 30 compressions. Defibrillator is charged to 200 joules. Okay, Kate, please pause chest compressions.

Stopping chest compressions. Deliver one shock, Patrick, please. Shock delivered.

Okay, Kate, continue chest compressions. Resuming chest compressions. All right, Edgar at our next pulse check, I'm going to ask you to intubate our patient.

All right, I'll prepare supplies to intubate the patient at the next pulse check. All right, Pat, could you please draw up one milligram of epinephrine? Drawing up one milligram of epinephrine.

And please deliver that when ready. Okay, one milligram epinephrine drawn up. One milligram of epinephrine given to the patient.Okay.

Edgar, how much time has passed since our last pulse check? It's been 90 seconds since our last pulse check. Edgar, can you please let me know when two minutes have passed.

I will let you know when two minutes have passed. At the conclusion of the case scenario, debrief the code team for approximately 10 minutes, focusing on the utilization of closed-loop communication, the leader's effectiveness in leading the resuscitation, and the management decisions as they relate to the advanced cardiac life support or advanced trauma life support algorithms. Then select another code team leader and repeat the process at the conclusion of the debriefing.

In this representative study, 100%of residents agreed or strongly agreed that the knowledge obtained during the blindfolded code training exercise could be transferred to the clinical setting. Most residents strongly agreed that the blindfolded code training exercise was more challenging, allowed them to apply critical thinking skills, and improved the use of closed-loop communication compared to typical code training exercises. Residents also felt that maintaining mental organization without visual cues was the most challenging part of this exercise.

It's important to review the rules with the learners before beginning the simulation and have all team members introduce themselves to the blindfolded code team leader. This innovative teaching technique can be applied to the management of any critically ill patient with the focus on developing more effective communication strategies in high-risk environments. Future directions for this study include utilizing validated assessment tools to evaluate teamwork, communication and leadership when comparing blindfolded to nonblindfolded team leaders in high-acuity situations.