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A Code For All Reasons

Justice Health and Forensic Mental Health Network
Project Added:
21 June 2018
Last updated:
6 July 2018

A Code For All Reasons


The Forensic Hospital adapted an existing emergency response training program to increase the confidence of clinical staff in dealing with medical emergencies.


To ensure 100 per cent of nursing staff in the Dee Why Unit of the Forensic Hospital are trained in the identification and coordinated response of medical emergencies, by 1 December 2017.


  • Improves patient safety and reduces the risk of clinical deterioration.
  • Empowers staff to confidently identify and manage a medical emergency.
  • Improves staff knowledge and fosters a supportive workplace environment.


In 2015, a review was undertaken at Long Bay Hospital, which acknowledged the need for increased training on acute care during medical emergencies. As a result, nursing unit managers and after-hours managers at Long Bay Hospital were provided with specific training in this area. This training was subsequently adapted and rolled out to all clinical staff at Long Bay Hospital.

This training was introduced to the Forensic Hospital in January 2017, for nursing unit managers and nurse managers only. It was determined that further adaptations were required before rolling out this training to all staff at the Forensic Hospital, to increase the confidence of clinical staff in dealing with medical emergencies. Prior to the project, staff were only required to complete the mandatory DRSABCD (Danger, Response, Send, Airway, Breathing, CPR, Defibrillation) training, which involved showing a trainer that they know how to perform CPR on a torso manikin.

Research shows that when self-confidence and self-efficacy is strong, staff are more willing to accept challenges, recover faster from failure and improve correct decision making.1 There is also evidence supporting the need for regular training using simulations and scenarios to counter the effect of skill deterioration, which usually occurs within 12 months of training. Refresher training every six to 12 months can improve skill retention and knowledge, therefore increasing confidence and competence.


  • A literature review of best practice standards in cardiopulmonary education was undertaken.
  • A 90-minute in-service education program was developed and introduced for all staff from July 2017. The training covered topics including:
    • identifying a medical emergency
    • performing chest compressions and ventilations
    • understanding how to use the equipment in the emergency response bag
    • strategies to lead an emergency response team.
  • The program used scenario-based training, with videos and full-length manikins, using trainers as ‘patients’. A clinical scenario was set up and participants were provided with a brief explanation of what was happening and what equipment was available. Participants had to work through the scenario with their team, to apply their learnings in a simulated environment. Scenarios included anaphylaxis, attempted hanging, serious deliberate self-harm wounds, choking, fitting and post-fit care.
  • Prompt card reminders were developed and distributed during the training, to remind participants of the basic steps when dealing with a medical emergency. This aligns to research that suggests frequent reminders help participants remember the steps in their training.
  • As this was new training for the Forensic Hospital, a mechanism for formal assessment and feedback of education sessions was developed and implemented following each training session. This informed the project team as to whether adaptations were required, how well staff were receiving the training, and whether outcomes were being measured.
  • Follow-up and remedial training sessions were provided for staff, with four sessions conducted during the 12-week project. Research was undertaken to identify how best to implement this training and develop scenarios. Liaison with nursing unit managers ensured there was enough time for staff to undertake training, provide feedback and participate in the evaluation.


Implementation – The project is ready for implementation or is currently being implemented, piloted or tested.


26 July 2017 – 1 December 2017

Implementation Site

Dee Why Unit, Forensic Hospital, JH&FMHN


Clinical Excellence Commission Clinical Leadership Program


All clinical staff (25 nurses) in the Dee Why Unit of the Forensic Hospital completed the training over four sessions held between August and December 2017. A Plan, Do, Study, Act (PDSA) approach was used, where each training session was improved based on feedback from participants in the previous session. Participants were asked whether the training enhanced their confidence, competence and overall knowledge.

Results from the evaluation showed that staff overwhelmingly felt more confident about attending a medical emergency and stated they wished to complete the training on a regular basis to keep the information ‘fresh’ in their minds. The training coordinator at the Forensic Hospital will roll out this training across all units of the hospital, with the follow-up and remedial training plans used as a template moving forward.

Lessons learnt

  • The project team were located in various metropolitan and regional areas of NSW, which meant planning needed to be focused and time used wisely.
  • CLP workshop days were used to plan the project, with phone calls in between to exchange ideas, provide updates and delegate tasks.
  • The team responsible for the delivery of the training quickly learned how valuable good-quality feedback is to adapting and improving the sessions. This feedback highlighted some obvious gaps that were able to be addressed in future sessions.
  • It is important to network with managers and ensure (as much as possible) you have buy in from them, so staff can be released from the floor to attend sessions and they are encouraged to continue their education.


  1. Hamilton R. Nurses knowledge and skill retention following cardiopulmonary resuscitation training: a review of the literature. Journal of Advanced Nursing 2005;51(3):288-97.

Further reading

  • Martins JC, Baptista RC, Coutinho V et al. Self-confidence for emergency intervention: adaptation and cultural validation of the Self-confidence Scale in nursing students. Revista Latino-Americana de Enfermagem 2014;22(4):554-61.
  • Massey D, Aitken L, Chaboyer W. The impact of a nurse led rapid response system on adverse, major adverse events and activation of the medical emergency team. Intensive and Critical Care Nursing 2015;31(2):83-90.
  • Gebbie K. The current status of nurses’ emergency preparedness: a commentary on the development of emergency preparedness and response competency [Letter to the Editor]. Collegian 2010;17(4):209-11.


Anne Fraser
Nurse Manager, Practice Development Unit
Justice Health and Forensic Mental Health Network
Phone: 02 9700 3839

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