HeartTalk with Susan Davis
WorldPoint met up with Susan Davis at the IMSH conference to learn more about Davis' resuscitation education program, CodePRep, which aims to improve the response to cardiac arrest in hospital settings.
Read the transcript below or watch the video!
Cristin
Susan, thank you so much for being here with us today on a HeartTalk. We have Susan Davis with CodePRep here with us today and we are at the IMSH conference, which is the International Medical Simulation Health Care conference in Orlando, Florida. So thank you for being here with us today. How are you feeling?
Susan
I'm feeling wonderful. It's exciting to be here. This is a really cool place.
Cristin
Yeah! So, Susan, we would love for you to tell us just a little bit about yourself.
Susan
So my name is Susan Davis, as we've said. I am a doctor of nursing practice and I am currently a resuscitation education specialist that's pivoting, if you will, and bringing a program that I have called CodePRep to the world.
Cristin
So that's why we're so excited to have you with us. We want to learn more about CodePRep and your new endeavor. Can you tell us about CodePRep?
Susan
So CodePRep is a really cool program that I created years ago now—actually been doing the program for about a decade almost in my local area. CodePrep is a resuscitation education program that is unit-based and it strongly reinforces the first 2 to 6 minutes of the cardiac arrest response in an in-hospital setting.
Cristin
Okay, wonderful. So tell us, how did you get into this space?
Susan
Well, I started my nursing career in the emergency room in a trauma E.R. and I'll never forget that my very first patient, my very first patient was a cardiac arrest—as a brand new nurse in a trauma E.R. So first patient, very first compression of my life on a human and it was a—it's an incredible experience to...to be in that moment and to be able to either keep somebody here on this planet and, or not, but based on your skills.
So I had a lot of experience in the emergency room, and we also would respond to codes in the inpatient environment. And I always found it—I found it kind of amazing that when you’d arrive in the inpatient into a code, it was so different than it was in the E.R. and it was really kind of a chaotic scene. And it always just kind of—I was wondering, you know, why? Why is it so chaotic in the—in the inpatient environment?
So I was amazed at the training. I wanted to look at the training. What's involved with the training? I mean, was it any different than mine as a nurse? You know, why am I so confident and able to do it in the emergency setting and maybe not so much in the inpatient environment? So that's where my journey on this—getting to the CPR space—started.
Cristin
Okay. Oh, wow. What makes CodePRep unique compared to other programs that focus on CPR performance?
Susan
Well, I'm not so sure there are many. Are there many? That focus on CPR performance? In fact, I don't know if there are—outside of a hospital setting. I know that many hospitals around the country in the world, not only because of regulatory bodies or some of their requirements, they'll do mock codes. And again, you know, when I left working in trauma, I went to run—I became the director of an American Heart Association program, a large American Heart Association program.
So I saw firsthand hundreds and hundreds and hundreds of healthcare providers coming through my classroom every week, how anxious they are about this. They're anxious in the classroom. I see them anxious in the clinical setting. And I once again I went back to that training. So what are what are we doing that we should be able to have a very smooth, easy response? I mean, it's basic life support. I think what happens quite frequently is people go instantly to the advanced measures in their mind. They're thinking, “Oh, you know, I don't do this, I'm not critical care. And so therefore I'm going to kind of get out of the way.”
So, anyway, that to me—there was a big disconnect. There's a huge gap. So I then witnessed not only firsthand in the clinical setting what we were seeing. And then in the classroom what we were seeing. And there's this gap, right? Because what all the resuscitation giants are saying that we should recertify, renew every two years, it's not translating to the bedside. That's all I knew.
So I made it my mission to—to bridge that gap. And that's what CodePRep was. I realized after studying mock code programs all over the world that really what I wanted to focus on was a code preparation program. CodePRep was born.
They needed to know what to do before we got there. So and that's the first 2 to 6 minutes. And if you look at the data and the research, everyone says, recognize a problem, call for help, begin CPR and use your electricity. And you've got 2 minutes to do that. So if the national average across the country for response teams to arrive on scene is about—in the hospital—is about 4.3 to 4.5 minutes, I'm not so sure that shocking’s happening in 2 minutes or less. I found that kind of a hard nut to swallow, if you will
So anyway, that's what that's what makes it different. It's—it's hands-on brief, repetitive practice in the clinical setting. Their equipment, their team, and ongoing—Cristin, ongoing—we're not we're not going to do it once on a random surprise attack. This is something that’s built in to go on forever.
Cristin
Right. Right. So what organizations have already implemented your program?
Susan
So I've been doing this for about a decade. So locally many, many acute care hospitals in my area and also outpatient areas, skilled nursing on SNFs, SNUs areas that don't have, let’s say, defibrillators, but AEDS. So, so many in my local area. The difference between what I've been doing the past ten years and today is I'm—I'm finally ready to bring it out of my local area. So I'm in about six acute care hospitals and—and that's every specialty, E.R., I.C.U, inpatient oncology, med surg, peds, PICU. Lots of different areas, radiology, respiratory, you name it. And the O.R..
Cristin
So what challenges do you see in optimizing clinical CPR performances?
Susan
Lots of challenges. I think the minimum standard—again, since the recommendation is once every two years for basic life support—and advanced and pediatric as well. All the research, you know—even the American Heart's own research—has been suggesting that two years is too long for a long time. I mean a long time. Early 90s, they started saying that that was too long.
So I think the difference between—another difference between CodePRep and what's out there is I want to put the research to work. I don't want to wait two years. If the research says, “Knowledge from those classes deteriorates as soon as three weeks after the course.” But yet our card is good for two years and then—and then again witnessing firsthand how anxious people get when it comes to this training. It's huge. So they need hands-on, brief, repetitive practice. Not —not rocket science. Just brief, repetitive practice. Ongoing. Two to six minutes. That's what CodePRep reinforces.
Cristin
So how do you incorporate your training with existing clinical training programs?
Susan
That that's a great question and that's something that I'm working on right now in many, many areas. I have to figure out how to—how to present it in a way that it does seamlessly go with existing procedures. So an easy answer is simulation. You know—alas, here we are at the simulation conference. But that's easy, simulation is to get me, they get it, CodePRep is simulation. And so that's an easy, easy entry for anyone who wants to just try it on for size, you know, and just try it. You can you can offer it in your simulation center and you can pick like a beta unit.
But we have found many ways to integrate CodePRep. CodePRep comes in on magnet hospitals as a as a ladder project. It comes in as performance improvement project for magnet, other hospitals who are on a journey of excellence. So that's using existing research—they're able to use my research. It’s been very —they love it in nursing orientation onboarding, charge nurse programs. So there's a million ways to integrate it.
I mean, my vision is that a system takes it on because it takes the system like it says in the European Resuscitation Union. They say take the system to save a life. I think it takes a community to save a life. So my vision is that we do it as a blanket for the whole system, and that's what I'm working on now. But there's many ways for programs to get started.
Cristin
Right. Oh, fantastic! So how will CodePRep help health care organizations to continuously improve the response to codes?
Susan
Well, that's the thing. It's a continuous quality improvement program. So I think one of the big differences between CodePRep and a mock code program is the variables in the length of time leading up to the actual mock code. So there's month-long study programs, there's online—there's three-hour programs to our programs. And then there have the actual event—which tends to be random—quarterly at best, and a random unit.
Cristin
Right.
Susan
And then a debrief of 20 minutes or 3 hours. Anyway, there are lots of variables. CodePRep is, has a one-hour, digital, online course and then there's a train-the-trainer course. And after that, it's ongoing. It's built into the calendar. So it's every month. Every unit it’s a rotating program. So once your unit has “code prepped,” the initial education, the the—I work with clinical educators, nursing professional development teams—and we make a calendar of ongoing.
So my recommendation is no more than six weeks, but ideally CodePRep—the cart and the equipment—will show up on their unit and it’ll stay for an entire week. Everyone is meant to do their drills, rescuer one, two, and three—once per shift—for that week, and then it rotates from, from like 2 East to 2 West and 2 West to—through the whole hospital until it rotates again. So it's ongoing. So we're not one and done. We're not a surprise attack. We're practice not—and not perfection. We're just looking for some fun.
Every unit, class, hospital or wherever I go into it begins with the assessment of what are they collecting for data now?And so then we measure that to what's happening in the world and evidence-based. I also train what I'm calling resuscitation officers. So that's like your lead stakeholder team on each campus, generally the ICU educators, your rapid response team, pharmacy, and respiratory. So that's six—as a team of six—so that the core group will be in the resuscitation education officer corner.
Cristin
Okay, fantastic. So what are some next steps for CodePRep?
Susan
(laughing) CodePRep’s going on break. My my goal again—my goal and my vision—I have an entire system using the program right now. It's just we've had one conundrum after another get us off the rails, pandemics, if you will, and then our local area, you know, we just were hit very hard by Hurricane Ian. And just prior to both of those, we were really cooking with oil.
So we were we had an entire implementation roll-out program and we were in we were going, you know, unit by unit by unit, hospital by hospital. And it was really coming together. And then the evidence starts stacking immediately, right, because if you use it, it works. You know, the beauty of it is the confidence in the people that are using it is a self-efficacy is something that I measured in my research and it's really important me—self-efficacy. So I always want to know—pre and post—how do they feel about it?
There's all kinds of numbers, you know, in resuscitation science. What are we collecting? Time to first compression, time to first epi, time to first defibrillation. A lot of numbers. I really want to know how they feel. Do they feel better? After they use the program than before. Yeah. And that's everything. Because if you're confident the numbers come. Right. And that that that's so again once they start using it, my, my vision is that we start saving a lot of people and then the nurses and/or other professionals—because it's an interdisciplinary program. I'm definitely creative with shared governance. You know, they go home knowing they did the best they could. And that's…that's huge.
Cristin
Is there anything else that you'd like to share with us?
Susan
You know, I just think that the resuscitation world, you know, the future of resuscitation is CodePRep. And I almost—it's almost silly saying that because it's like, how could it be like, how could it be so grand and so different? It's not. I'm just taking the science and putting it to work. Yeah! We need to do brief, repetitive, ongoing, hands-on practice with their equipment in their—in their system and in their unit and with their teams. And that's what I'm doing.
So it's not rocket science, it's less-is-more approach and it's fun and it really gives confidence and ultimately outcomes. It's always about the outcomes and they improve. Easy. Right.
Cristin
Well, Dr. Susan Davis, thank you for being here with us today. We're so excited for CodePRep and the future of CodePRep. And thank you for all that you do every day to help save lives.
Susan
Thank you. My pleasure. Great to be here. Thank you.
