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Revised Code Blue Record and Get With the Guidelines-Resuscitation Justin Hamilton, BSN, RN Aultman Hospital Critical Care Coordinator Completion of this Learning Module is mandatory for RN’s and LPN’s within Aultman Hospital who currently utilize the Code Blue Record to document a Code Blue event. Read the information contained in this learning module. Read and sign the Accountability Form entitled: Revised Code Blue Record and Get With the Guidelines-Resuscitation Completion Deadline: June 15, 2012 Information and Instructions Objectives: At the end of this learning module, the nurse should be able to: ◦ Identify the documentation revisions made to the Code Blue Record. ◦ Discuss the intent American Heart Association (AHA) Get With the Guidelines-Resuscitation (GWTG-R) Program. Objectives AULTMAN CODE BLUE RECORD PATIENT LABEL Onset Information: Initial Breathing: Initial Ventilation: Circulation Intubation: Confirmation: □ Spontaneous □ Agonal □ Apnea □ Ventilator Time of first assisted ventilation: __________ □ Bag-Valve-Mask □ Endotracheal tube □ Tracheostomy □ Other: __________________ □ NO □ YES: Time: _________ Size: ________ By Whom: _____________________ □ Ausculatation □ End CO2 □ Other: _____________________________________ 1st PULSELESS rhythm: __________ time: ______ Compressions: □ None □ Manual AED Applied: □ NO □ YES: time: ______ External Pacemaker: □ NO □ YES: time: _________ settings: ____ ma _____ rate _____mode IV Access Type: ___ peripheral: □ new □ prior location(s):______________ If new line, inserted by: _____________________ Responders Airway/resps Date: __________ Time: __________ Location: ______________ Code Status Prior:__________ Hospital-wide resuscitation response activate: □ YES □ NO Witnessed: □ YES □ NO Conscious at onset? □ YES □ NO Pulse at onset: □ NONE □ WEAK □ PRESENT Weight: ________ Height: _____________ EVENT TYPE: □ Respiratory Arrest □ Respiratory leading to Cardiopulmonary Arrest □ Cardiac Arrest Monitoring at Onset: ECG Pulse Oximeter Apnea Charge Physician: ___________________________ Physician: ____________________ Physician: ________________________ Respiratory-1: ________________________ ___ central line: □ new □ prior location(s):_____________ If new line, inserted by: _____________________ Respiratory-2: ______________________ RN Code Coordinator: _______________________ Medication/CV RN: ________________________ Supervisor: _____________________ Floor Nurse: _____________________ Recorder: ____________________ Recorder sign: ______________________ Charge Physician sign: ____________________________ Outcome ***Patient Physician notified: Dr. ______________________ notified by: __________________________ time: _____________ Time Code ended: ________ Reason ended: □ Return of Circulation □ Efforts Terminated □ Family Request Status: □ SURVIVED □ EXPIRED Family present for code: □ YES □ NO if no: Family member notified: __________________ by: __________________ Time: _________ Destination: ___________________ Candidate for Hypothermia Protocol? □ YES □ NO BOLUS Emergency Medications: OTHER BOLUS MEDICATIONS and INFUSIONS: EPINEPHRINE ATROPINE AMIODARONE BICARB Time: Dose/Route: ______ _________ Time: Dose/Route: ______ ________ Time: Dose/Route: ______ ________ Time: Dose/Route: ______ ________ ______ _________ ______ ________ ______ ______ ______ _________ ______ ________ ______ _________ ______ ________ ______ _________ ______ ________ ________ _______ ________________ _________ _______ ________________ _________ _______ %SAT BP IVF: _________ _ VITAL SIGNS OTHER *KEY: Pulse: C=compressions resps: B=bagged Mg/min _______ ________ Amiodarone _________ ______ Mcg/kg/min ________________ ______ ________ Dopamine ______ _________ ______ _________ Mcg/min _______ Levophed _______ _________ (joules) _________ ________________ Defribrillator ________________ Rhythm LIDOCAINE ______ ________ resps* ROUTE: _________ Time: Dose/Route: ______ _________ ______ _________ Pulse* TIME: ________________ VASOPRESSIN Time: Dose/Route: ______ ________ TIME DRUG/DOSE: ________ CODE EVENTS (labs, line insertion, etc.) Precode Form 399 (93400) R: 12/10 White: CHART Yellow: Critical Care Coordinator PAGE _____ of ______ PROGRESS NOTES Code Blue Record Revision Four Additions Under “Onset Information:” 1. Code Status Prior Blank to be filled in by Recorder Yes if code was paged overhead No if code was not paged overhead (ICU situations where physician is present and able to intubate patient or physician present and patient previously intubated) 2. Hospital-wide resuscitation response active 3. Height Blank to be filled in by Recorder ECG (Telemetry monitor or ICU monitor), Pulse oximeter, or Apnea, these boxes should be checked if patient was ordered to have these monitors in use 4. Monitoring at onset: What was changed on the Code Blue Record? AULTMAN CODE BLUE RECORD Was code paged overhead? Onset Information: Indicate Code Status Prior to the Code Event. Date: __________ Time: __________ Location: ______________ Code Status Prior:__________ Hospital-wide resuscitation response activate: □ YES □ NO Fill in the patient’s height. Witnessed: □ YES □ NO Conscious at onset? □ YES □ NO Pulse at onset: □ NONE □ WEAK □ PRESENT Weight: ________ Height: _____________ EVENT TYPE: □ Respiratory Arrest □ Respiratory leading to Cardiopulmonary Arrest □ Cardiac Arrest Monitoring at Onset: ECG Pulse Oximeter Apnea Indicate any monitoring that was ordered prior to the initiation of the code. Changes at a glance… Form 399A will be an addendum sheet that will be formatted identical to the bottom box on the present Code Blue Record. ◦ This page will be utilized to document once the initial spaces are filled in. ◦ The Recorder then must fill in the “Page_of_” section at the bottom of all forms. Code Blue Record Addendum AULTMAN CODE BLUE RECORD PATIENT LABEL Form 399A (93412) R: 05/12 White Copy: Chart Form 399A: Yellow Copy: Critical Care Coordinator PAGE ___ of ___ IVF: _______ BP Other %SAT Amiodarone Mg/min Pulse* Resps* Dopamine (Mcg/kg/min TIME Levophed Mcg/min *KEY: Pulse: C = Compressions Resps: B +Bagged Defibrillator (joules) VITAL SIGNS Rhythm VITAL SIGNS CODE EVENTS (labs, line insertion, etc.) PROGESS NOTES Code Blue Record / Vital Signs The Code Blue Record was changed in preparation for the participation of Aultman Hospital in the American Heart Association (AHA) Get With the Guidelines-Resuscitation (GWTG-R) Program. The additional sections will allow for more efficient data entry into the GWTG-R database by Intensivist team nurses. Why was the Code Blue Record Changed? GWTG-R is a program that allows hospitals to enter and review arrest events. The participating hospitals can then make changes to ensure that they are providing the best possible outcomes for their patient populations. Individual hospital data can be compared to other similar facilities participating in the GWTG-R program. Participating hospitals will be eligible to receive Bronze, Silver, and Gold Awards based on the achievement of set outcomes. What is GWTG-R? Following the Code Blue event, the white copy of the Code Blue Record should be placed on the patient’s medical record. The yellow carbon copy of the Code Blue Record should be detached, placed in an envelop and sent to Medical Intensive Care or Justin Hamilton, Critical Care Coordinator through Interoffice Mail. (CCU nurses: please note we have these envelopes on our code carts!!) What is GWTG-R? CONTINUED Hospitals must achieve 85% compliance in the following four outcomes to be recognized by the AHA for GWTG-R awards: 1. Time to first chest compressions <= 1 minute in adult and pediatric patients. 2. Time to first shock <= 2 minutes for VF (Ventricular Fibrillation)/pulseless VT (Ventricular Tachycardia) first documented rhythm. 3. Pulseless cardiac events monitored or witnessed at the time of arrest. 4. Device confirmation of correct endotracheal tube placement (End Tital CO2 Cap or Capnometry device supplied with all endotracheal intubation trays presently on Code Carts). GWTG-R Outcomes All information pertaining to GWTG-R obtained from The American Heart Association web site: http://www.heart.org/HEARTORG/HealthcareRes earch/GetWithTheGuidelines-Resuscitation/GetWith-The-GuidelinesResuscitation_UCM_314496_SubHomePage.jsp References For any questions please contact: Justin Hamilton, BSN, RN Office Phone: (330) 363-4284 Email: [email protected] Questions / Contact Information After you have completely read and understand this material, please enter the Quiz section of Quia and complete the Accountability Form for Revised Code Blue Record and Get With the GuidelinesResuscitation. Accountability Form