Rolling-refresher simulation improves performance and retention of paediatric intensive care unit nurse code cart management

Marcy N. Singleton*, Kimberly F. Allen, Zhongze Li, Kevin McNerney, Urs H. Naber, Matthew S. Braga

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Introduction Paediatric Intensive Care Unit Nurses (PICU RNs) manage the code cart during paediatric emergencies at the Children's Hospital at Dartmouth-Hitchcock. These are low-frequency, high-stakes events. Methods An uncontrolled intervention study with 6-month follow-up. A collaboration of physician and nursing experts developed a rolling-refresher training programme consisting of five simulated scenarios, including 22 code cart skills, to establish nursing code cart competency. The cohort of PICU RNs underwent a competency assessment in training 1. To achieve competence, the participating RN received immediate feedback and instruction and repeated each task until mastery during training 1. The competencies were repeated 6 months later, designated training 2. Results Thirty-two RNs participated in training 1. Sixteen RNs (50%) completed the second training. Our rolling-refresher training programme resulted in a 43% reduction in the odds of first attempt failures between training 1 and training 2 (p=0.01). Multivariate linear regression evaluating the difference in first attempt failure between training 1 and training 2 revealed that the following covariates were not significantly associated with this improvement: interval Paediatric Advanced Life Support training, interval use of the code cart or defibrillator (either real or simulated) and time between training sessions. Univariate analysis between the two trainings revealed a statistically significant reduction in first attempt failures for: preparing an epinephrine infusion (72% vs 41%, p=0.04) and providing bag-mask ventilation (28% vs 0%, p=0.02). Conclusions Our rolling-refresher training programme demonstrated significant improvement in performance for low-frequency, high-risk skills required to manage a paediatric code cart with retention after initial training.

Original languageEnglish (US)
Pages (from-to)77-82
Number of pages6
JournalBMJ Simulation and Technology Enhanced Learning
Issue number2
StatePublished - Apr 2018


  • Code Cart
  • Nursing
  • Rolling Refresher

ASJC Scopus subject areas

  • Education
  • Health Informatics
  • Modeling and Simulation


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