Implementing a Post-Code Moment of Silence

Introduction
A post-code moment of silence is a designated set of time (a few seconds to a minute) of silence at the end of a code-event when a patient dies to reflect. It is a mindful moment of silence, without action or medicine, to honor a life that has just ended; and time to reflect on the gravity of the role that health care providers play in caring for patients and their families. It may also provide a way to build capacity and resiliency in one of the most difficult clinical situations.

Objectives
To increase the frequency in which this moment of silence occurs at Kapi’olani Medical Center for Women and Children (KMCWC).
To understand attitudes and barriers to having this moment of silence.
To identify and implement ways to lower the barriers for staff to be able to process and move forward after difficult outcomes.

Methods
Data was collected using a pre-implementation survey, followed by educational sessions for the emergency department (ED) and pediatric intensive care unit (PICU) staff at KMCWC. Surveys contained directed questions on previous participation in such events, assessed willingness to participate/lead; as well as open ended questions on overall attitudes and thoughts on participation. Surveys had voluntary participation, using a QR code link on flyers posted in each unit and in staff emails. Educational sessions consisted of reviewing the potential benefits for a moment of silence with ED and PICU physicians, and reviewing sample scripts for initiating. Similar sessions occurred at daily nursing huddles. Development of a script on code-carts in on-going, and a post-implementation survey tool will be distributed in early 2024 to better assess frequency and reassess staff viewpoints of such events.

Results
Of 63 completed surveys, 23% participated in a moment of silence at KMCWC, 31% indicating prior participation in their careers. The majority of respondents, 57.2% indicated feeling comfortable to very comfortable participating in a moment of silence with 9.6% indicating feeling uncomfortable. 21% of those surveyed were comfortable with initiating a post-code moment of silence. Qualitative data collected indicates that healthcare workers are open to moments of silence and find it beneficial. Responses included: “helps to check in with yourself and also take a moment before returning to ‘usual’ duties’” and “extremely beneficial to recognize the patient as a person and human aspect of what we are doing.” Barriers identified were time for a moment of silence, “can be tough depending on what else is going on in the unit” and leadership of the moment; “involvement of the code leader is crucial.” KMCWC is exploring moments of silence into a system-wide effort for improving debriefing.

Discussion
Implementing and educating staff about post-code moment of silence is possible. Staff responses are overall positive. Champions are a must for implementation, guidelines, and pediatric specific scripts would likely aid in occurrence and frequency. Further exploration of utility and benefit is on-going.