Download CHOA at Egleston Code Blue Procedures

CHOA at Egleston
Code Blue Procedures
Updated November 2008 by
Leah Hatfield PharmD, BCPS
Objectives
Familiarize the pharmacist with the
activities that occur during a Code Blue
 Identify the procedures followed during a
Code Blue
 Delineate the role of the pharmacist as a
team member during Code Blue
 Evaluate appropriate conduct during Code
Blue events

Why Should Pharmacists
Participate in Code Blue?

Use of medications is inherent

Increases likelihood of safe and correct prep
and administration
Preparation of IV medication falls under
purview and expertise of pharmacists
 Dynamic and highly interactive part of
optimal pharmaceutical care

Crash Cart Locations
Always know location of crash cart on your
unit and in the trauma rooms
 Replacement medication trays are kept in
both ICU and Main pharmacy


New trays are needed post-code when cart is
cleaned and meds and instruments replaced
CHOA ECH Crash Cart
Cart Records
Defibrillator
Med Labels
Airway and
Respiratory
Equipment
Oxygen
Canister
Lock Device
ECH Crash Cart Components
TwinPaks
Needles
Tape
Scissors
Pens
Medication Tray
Large Syringes
Small Syringes
Nursing
Supplies and
Equipment
CHOA ECH Code Bag
Medications
and Syringes
Flushes and
Labels
Drug Info
Calculator
ECH Code Bag Components
Writing Pen
Alcohol Swabs
Dispensing Pin
Spikes
Fluid Bags
Premix Bags
Flushes and
Labels
Hi Dose EPI
Antibiotics
Electrolytes
Mannitol
Large Vial Meds
Small Vial Meds
TwinPaks
Needles
Filters
Heparins
Syringes
Attending a Code Blue

Notification
Overhead PA system
 Phone call to pharmacy

ALWAYS take the Code Bag!
 Reach site of code

Take stairs when possible, use fastest route
 Enter room / area and immediately identify
yourself to staff already in attendance

Pharmacist Procedures

Ask for patient’s code sheet

Place where it can be readily viewed
Open code bag so supplies are accessible
 Open med tray in crash cart
 Notify individuals using crash cart that you
will handle medications


Ask for assistance if overwhelmed
Pharmacist Procedures

Try to gather synopsis of what happened
Patient’s age/ history
 Events leading up to code
 Weight and allergies

Identify physician running code
 Identify code recorder

Pharmacist Procedures

Stand by tray and code bag
Be sure to stay in sight and earshot of MD
running the code
 Try to be in view of ECG monitor if possible

Syringe Preparation
When you arrive, prepare epinephrine
syringe and label immediately
 Unwrap and/or draw up several NS
flushes
 Use the most appropriate syringe size for
dose based on code sheet

Syringe Preparation

CHOA is a needle-less healthcare system
You may use needles to draw up meds if
necessary
 ALWAYS replace needles with blunt tip
cannulas before handing of to RN or MD

 Use
Twinpaks (needle and cannula device)
 Use blunt cannulas on larger vials
 Use syringe connectors if easier
Use of TwinPak Device
Pharmacist Procedures
Obtain IV meds, solutions, syringes, and
needles from bag / cart when requested
 Stay focused and listen for requests



May repeat back if uncertain you heard clearly
Try to think one step ahead

Prepare additional doses of meds if
necessary
Dispensing Medications
Draw up requested meds, assemble
syringes, exchange needles if necessary
 Label meds with appropriate stickers
immediately
 Step to bedside once med is ready


Loudly read name and dose of medication as
you hand to administering RN or MD
 Ensures
correct med is being dispensed
 Double-check that correct med is administered
Dispensing Medications
Return to stand by medication tray
 Record meds and time administered if
possible



Make sure recorder has correct records at the
end of the code
Draw up another syringe of medication just
used if appropriate
Helpful Hints

Code sheets spell out EXACT amounts of
medications needed


Preparation instructions and reminders
Keep track of what you’ve used
MD may ask how many doses have already
been given
 Watch timing between doses of epi (3-5 mins)
 Recorder should corroborate counts of meds
and timing for records

Helpful Hints

Wearing gloves in a Code Blue situation is not
mandatory, but be careful!



Be aware that you could be exposed to blood or
bodily fluids
Know where to find gloves and keep some nearby in
case necessary
If you use needles or other sharps:


Re-cap used needles and sharps, place in safe spot
out of your way to prevent accidental sticks or injuries
Dispose properly at the end of the code
Professional Conduct
Always remain focused on MD running the
code, listen for requests
 Watch and be aware of events going on
around you


Be courteous to others using cart
Professional Conduct
NEVER leave a code that is in progress!
 If additional supplies or help are needed
there are always extra bystanders:

Send extra RN’s to Pyxis
 Have someone call pharmacy for back-up
 Send someone to tube to retrieve meds
 Send someone to pharmacy to retrieve meds

Professional Conduct

End of Code
Always ask permission to leave
 Make sure all medication needs are complete
 Clean up your area

 Dispose
of trash
 Sharps to appropriate container
Conclusion

Remember to take a deep breath and
pause to think when necessary

Always remain calm and in control
Each code you attend will be different
 Participation becomes easier with each
time you attend
 You are an important asset to a team that
may save a child’s life!!!
