Table 3.
Examples of Defects Identified during Mock Codes and Corrective Measures Taken After Simulation Mock Codes
| Identified Defects | Corrective Measures |
|---|---|
| Transporting suspected COVID-19 patient pathway was through a room that has patients at the time of transfer | Assign that room as a passage and never use to assess patients |
| Wheelchair and bed for transport too big to pass through one of the doors in respiratory pathway | Smaller wheelchairs and stretchers were provided for transport |
| Mixing of patients (respiratory and non-respiratory) was noted when eyeball nurse leaves his/her position to escort a patient to vital signs room | Back up nurse (two nurses for eyeballing) |
| Ante-room for isolation was missing certain sizes of N95, face shields | Provide the missing sizes of N95, face shields |
| Only one O2 port available in isolation rooms | Provide O2 cylinder in the area for cases when two ports are needed |
| Wall-mounted suction in isolation room was not working | Fixation requested |
| Biohazard bin for disposing of the gown and gloves was outside the patient room | Biohazard bins were pushed inside patient room, as per hospital infection control policy |
| Communication from inside the isolation room was difficult; someone must come out | Communication through zello (a push-to-talk, Wi-Fi-based application) from inside the room to the runner nurse |
| Glidescope Stylet in resus was missing and it took significant time to get from another room | Include in daily checklist of resuscitation room |
| Some physicians were only trained on laryngoscope, not Glidescope | Orient and train all physicians on Glidescope |
| Proper sequence of donning and doffing was not followed by all team members | Train and post a big clear picture of donning and doffing techniques in areas of PPE |
| Only Respiratory Therapist knows location of ventilator | Keep ventilator stationed on standby at same place |
| Yellow gowns easily torn while EMTs move patient for transportation, blue gown (limited stock) | Allow use of blue gowns for transportation |
| Patients in isolation sent to x-ray suite though portable x-ray machines can fit inside isolation rooms when tested | Perform x-ray in room, no transfer to x-ray suite |
| Use of acrylic intubation box caused significant delay in intubation process, owing to new environment in one of the mock codes | Stop use of the box till further training |
| Owing to rapid changes in guidance and chance of spreading infection when starting O2 on COVID-19, delay and hesitancy were noted in starting O2 therapy when needed in scenario | Draw attention to this, and thoroughly discuss concerns during debriefing |
Abbreviations: EMT, emergency medical technician; PPE, personal protective equipment.