A code or rapid response announced over the hospital PA system typically leads to a flurry of activity and a swarm of people responding to the patient’s needs. Many steps of the ACLS algorithm happen rapidly and concurrently, and can be difficult to track with accurate timestamps by the person assigned the role of scribe.

Clear and accurate documentation is critical for post-event analysis to demonstrate the team did everything according to standards and determine if things could have gone better. Many facilities use a code sheet kept on or near the crash cart and others use real-time charting in the EHR. Often the details are written on scrap paper and added to a document later. All of these methods are cumbersome and can lead to inaccurate data collection.

Using an app for documentation during code events.

This month’s Cultivating Quality article, “Improving Accuracy in Documenting Cardiopulmonary Arrest Events,” describes the use at one hospital (Beth Israel Deaconess Medical Center in Boston) of a handheld electronic device for code documentation that makes it simpler and more organized to capture this information.

The project took place on four medical–surgical pilot units, where nurses were trained in the use of a documentation app for live cardiopulmonary arrest events. The American Heart Association’s Full Code Pro app is available for free in the iOS app store. The app has buttons for the steps of the ACLS algorithm, such as CPR, shock, epinephrine, and rhythm check, and keeps note of times that each intervention occurs. There is also a metronome to help keep the time of chest compressions.

Improved accuracy in documentation.

The authors found that:

“Data accuracy was significantly greater in the electronic group compared with the paper-based group for recorded rhythm (100% versus 13%, P = 0.01) and end-tidal carbon dioxide (67% versus 0%, P = 0.02). The electronic method significantly outperformed the paper-based method in legibility (100% versus 13%, P < 0.01). Staff reported increased satisfaction with the electronic documentation method.”

The authors conclude that “electronic documentation was superior to paper in overall documentation quality and allowed providers to identify and quickly document the initial rhythm of the event.”

Because this was a small study, the authors recommend that a larger study be performed in the future to further determine the benefits of using this method of documentation.

Christine Moffa, PhD, APRN, PMHNP-BC, senior clinical editor, AJN