Download Code Blue Resuscitation Services – page 1 PROCEDURE TITLE

PROCEDURE
TITLE: Code Blue Resuscitation Services
Issuing Department:
Emergency Management
Clinical Director Signature:
Departments Involved:
All Clinical Departments
Effective Date:
04/84
Review Dates:
09/04
Revision Dates:
06/01, 01/08, 08/09, 01/10, 09/10, 05/13
(This policy rescinds any previous publication covering the same material)
I. PURPOSE
A. To outline procedures for resuscitation services to the patient with a cardiac or pulmonary
emergency.
B. Cardiopulmonary Resuscitation (CPR) will be initiated as soon as possible after cardiac
arrest to minimize brain damage and increase the patient’s probability of survival.
C. To outline procedures for assigning duties and responsibilities for members of Code Blue
Teams.
D. To promote quality and safe patient care in response to Code Blue resuscitation and other
emergencies by standardizing equipment, medications, and supplies.
II. EQUIPMENT
A. Crash Carts for adults are located in Special Care, Med-Surg, OB, PACU, ED, and Endo.
Radiology has a small med box.
B. Pediatric Crash Carts are located on Med-Surg and ED.
C. Pediatric Med Boxes are located in Ambulatory Care and PACU.
D. Braeslow tapes and books are located in PACU, Ambulatory, Med-Surg, ED Crash Cart
and ED Pediatric Crash Cart.
E. Newborn Med Boxes are located in Nursery and OB/OR.
F.
Emergency drug boxes (see procedure “Provision for Emergency Drugs”).
G. Crash Carts and Defibrillators will be checked each day. (See attach A for supply list) It is
the charge nurse’s responsibility to make sure this is done. Instructions for testing the
Code Blue Resuscitation Services – page 2
defibrillators are located with each defibrillator based on manufacturing instructions.
Document code cart checks.
H. Restocking
1. Following a Code Blue, the patient’s primary nurse will make a list of all equipment
utilized from the cart. A preprinted list of supplies will be kept with the record sheet for
convenience. (See attachment A)
2. The cart must be restocked immediately.
3. The primary nurse is to make every effort to restock the cart. If the primary nurse does
not believe that he/she will have adequate time to restock he/she will:
a. Notify the charge nurse, if available, and charge nurse will restock or assign
someone to restock the cart using the above described list.
b. Notify the Department Manager and if unable the Manager on Call / Clinical
Supervisor will restock the cart using the above described list.
c. Pharmacy will be notified immediately if drug box has been opened during a code.
Pharmacy will replace drugs / drug box immediately with new break-away lock in
place.
d. Respiratory Therapy will replace any items used from the Airway Tray including
Ambu bag.
e. After hours when Pharmacy is closed, call Clinical Supervisor / Manager on Call for
a replacement drug box.
I.
Emergency key to unlock the crash cart will be kept in the Pyxis under “Crash Cart Key.”
III. PROCEDURE
A. Upon discovering a patient in cardiac or pulmonary arrest
1. Initiate American Heart Protocol for BLS, PALS, NRP, ACLS based on patient age.
2. Summon assistance by directing another staff member to make a Code Blue
announcement over the paging system or by personally making the page.
3. To page Code Blue, dial 800 and announce “Code Blue” and location. After initial
page, the operator will repeat “Code Blue” and the location three times to alert Code
Blue team to respond.
B. Special consideration for pregnant women
1. Pull the gravid uterus laterally to relieve pressure on the inferior vena cava by placing a
pillow or wedge under the right hip.
Code Blue Resuscitation Services – page 3
IV. CODE TEAM ASSIGNMENTS
A. Code Team assignments will be made by the nursing supervisor every 24 hours and posted
on the nursing units before 7pm. Code Team assignments will be based on census, patient
acuity and availability of staff. Respiratory Therapist will be responsible for airway and
ventilation.
B. Members of the Code Blue Team will be summoned to the emergency by the Code Blue
page.
C. Physician: The Emergency Department physician will respond to all codes within the
hospital. The ED physician will coordinate, direct, and manage the code event. The
attending physician will respond to do post code care
D. Nurse A: (The patient’s primary nurse) Controls and starts resuscitation until Code Team
arrives at the bedside. Stays at the beside to provide patient history and any other pertinent
information. Assists with vital signs, inserting additional IV’s and compressions as directed
by the Clinical Supervisor. Notifies attending physician.
E. Nurse B: Brings crash cart to the room, inserts additional IV’s, administers medications,
compressions as directed by the Clinical Supervisor. Assist family as necessary.
F.
OB Nurse: Records all pertinent facts about code on the Code Blue form. Makes sure that
the code sheet is signed appropriately by the physician and primary nurse.
G. Clinical Supervisor: Control room flow assigns roles and assists with coordination of code.
Administration of ACLS medications and monitor control (including defibrillation). After
the code blue notifies the coroner and notifies appropriate personnel for organ
donation/procurement.
H. Patient Advocate: When available, remains outside of patient room, controls traffic control
outside of code room. Assists with family, as necessary. When Patient Advocate is
unavailable, every effort will be made to have Nurse B assist family. If needed, may call
security for traffic control outside rooms when Advocate is unavailable.
I.
Respiratory Therapy: Takes over management of patient’s airway. Will assist the
physician with intubation, if no physician is able to respond, respiratory therapy will
intubate the patient. Respiratory will document all treatments provided for airway care.
J.
Unit Assistant / AOE: Provide compressions as directed by the Clinical Supervisor.
V. TRAINING QUALIFICATIONS
A. Qualified personnel who have been successfully certified by a program overseen by the
American Heart Association (AHA) may initiate basic CPR at the scene of a
cardiopulmonary emergency.
B. In the absence of a physician, an ACLS certified RN may institute resuscitative measures,
i.e., defibrillation and administration of specific intravenous drugs using approved ACLS
algorithms.
Code Blue Resuscitation Services – page 4
C. All SCU, ER, OR and Ambulatory Care RNs will maintain certification in Advanced
Cardiac Life Support and demonstrate their ability to:
1. Interpret electrocardiogram information and recognize significant dysrhythmias and
their treatment.
2. Use knowledgeably specific drugs required for resuscitative measures.
D. All patient care staff will maintain certification in Basic Life Support (BLS).
E. Mock code drills will be held quarterly on all units within the hospital. The Code
Committee will schedule and present the mock code to all nursing units within the hospital.
The Code Committee will have quarterly meetings.
VI.
PRECAUTIONS
A. Brain death can occur within 3 to 6 minutes after cardiac arrest.
B. Broken ribs, sternum fracture, punctured lungs or pneumothroax can occur from improper
hand placement during external cardiac compressions and/or external cardiac thump.
C. Improper hand placement during cardiac compressions which press on the Xyphoid process
can lacerate the liver or spleen.
D. Compressions which are too hard can cause cardiac contusions.
E. Excessive pressures used to inflate the lungs and inadequate airways can cause gastric
distention.
VII. SECURING THE CART
A. Pharmacy routinely checks for outdated drugs according to their procedures.
B. Respiratory Therapy routinely checks for outdated items in airway tray.
C. Code carts are to be locked at all times.
1. If the cart is unlocked and/or cart contents used at any time, follow re-stocking
procedure.
D. Carts are secured in a locked area during non-operational hours of a department.
VIII. PATIENT EMERGENCIES AT OFF-SITE BUILDINGS
A.
Applies to:
1. Company Care
2. Outpatient Rehab
3. Sleep Lab
Code Blue Resuscitation Services – page 5
B. Response:
1. Institute CPR and call 9-1-1
IX. FAMILY PRESENCE AT THE BEDSIDE DURING RESUSCITATION
A. Family members of all patients who are undergoing resuscitation will be given the option of
being present at the bedside.
B. Nursing staff / patient advocate / social services will be present with the family during
resuscitation.
X. REFERENCE
A. TJC, 2009.
B. Ohio State Pharmacy Board.
C. American Heart Association.
Code Blue Resuscitation Services – page 6
ATTACHMENT A
MED-SURG CRASH CART CONTENTS
TOP SHELF
 LifePak 20
 (1 set) Quik Combo Pads
 (1) Adult Ambu Bag
 (1 box) Size Small Gloves
 (1) Clipboard with Crash Cart Inventory List
 (1) Clipboard with Code Blue Summary Sheet
 (1) Handbook of Emergency Cardiovascular Care
 (1) LifePak 20e Def/Monitor Operations Instructions
DRAWER 1 “RESPIRATORY”
 Enclosed tray which is locked:
o Tape
o Saline
o Oral Airways
o Nasal Airways
o ABG kit
o Surgilube
o 10cc Syringe
o Batteries
o Miller #2 and 3 blades
o Mac #3 and 4 blades
o Handles
o Stylet
o Yankauer / NT Suction
o ETT sizes 6.0-8.5
o Fenum CO2 Detector
o ETT Holder
o Extra Batteries
DRAWER 2 “PHARMACY”
 Enclosed tray which is locked:
o (1) Adult Code Blue Drug Box
DRAWER 3 “PHARMACY”
 Enclosed tray with additional Code Blue Drugs – Pediatric Medications where stocked
 (1) Dopamine Drip Infusion
 (1) Dobutamine Drip Infusion with a concentration drug reference
 (1) Lidocaine Infusion Drip
DRAWER 4 “MISC” SUPPLIES
 Salem Sump Tubing – (1) 14 Fr, (2) 16 Fr and (1) 16 Fr
 (1) Bulb Syringe
 (2) 60 cc Syringes
 (2 pr) Size 7 ½ Sterile Gloves
 (1) Denture Cup
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(1) Bite Block
(1 roll) Paper Tape
(4) Yankauer Suction Tips
(2) Catheter and Glove Suction Kits
(1) 6 Fr Suction Catheter
(1) 8 Fr Suction Catheter
(2) Quik Combo Pads
(3 rolls) Monitor Paper
Spinal Needles: (1) 25x3 ½, (2) 20x3 ½, (1) 22x3 ½, (1) 18x3 ½
(3) Electrode Prep Pads
Several Monitoring Electrode Patches
(2 pkgs) Surgi-Lube
(4) Suction Connectors
(3) Catheter Plugs
(2) Y Plastic Tubing Connectors
(2) Stopcocks
(7) Coverlet Adhesive Dressings
DRAWER 5 “IV SUPPLIES”
 (2) 1000cc 0.9 NS IV Solution
 (2) Primary Pump Tubing
 (2) Secondary Pump Tubing
 Angiocaths: (4) 22G, (3) 24G, (3) 18G, (8) 20G
 (3) Hep Lock Luer Devices
 (2) IV Start Kits (saline locks)
 (2) Needleless Inline IV Start Kits
 Several Alcohol Prep Pads
 (7) Saline Flushes
 (7) 3cc Syringes
 (6) 5cc Syringes
 (4) 10cc Syringes
 (10) Monoject – Smart Tips
 (5) 19 G 1 ½” Filter Needles
 (4) Razors
 93) ChloraPrep One Step Frepp Applicators
 (4) Orange Medication Added Stickers
 (1 roll) Cloth Tape
 (1 roll) Adhesive Tape
 (1) 2” Coban
 (1) 3” Coban
DRAWER 6
 (1) Multi Lumen Central Venous Cath Kit
 (1 set) Cable Wires
 (2) Large Disposable Personnel Protection Gowns
 (1) Sterile Gown and Towel Set