Code Blue Lab Nursing 228

1
Code Blue Lab Nursing 228

• Almost ½ of all patients who code exhibit warning
  signs up to 6 hrs prior to their arrest
• heart rate lt 45 , gt 125
• Respiratory rate lt 10,
• gt 30
• Chest pain
• Altered mental state

2
Signs of Impending Code

• Changes can be acute or gradual!
• Recognizing vital signs trends and changes is
  CRUCIAL!
• It takes a more perceptive nurse to anticipate
  and prevent a code, than to run a code well.

3
Before a Code is called

• Assess the patient
• Look for signs of
• Restlessness
• Dizziness
• new pain in any location
• changes in
• level of consciousness
• vital signs
• labs, CBC, or electrolytes such as potassium

4
What to Do I Do If I Think My Patient is Going to
Code?

• Let the nurse responsible for the patients care
  / Charge nurse / your clinical instructor know
  immediately of changes in your patients
  condition !
• PCAT team can be called as soon as the nurse
  identifies changes in the patients condition
• Reassess the patient frequently

5
Calling the Code

• Dial 45555
• Operator will answer
• Identify the emergency Code Blue
• Identify the facility (Main, Orthopaedic) and the
  room Number
• Note the time using the clock in the patients
  room
• The primary nurse must be in the patients room
  until the end of the code

6
Prior to the Code Team Arriving

• Put on appropriate PPE
• Start CPR
• Airway
• Breathing
• Circulation
• Defibrillation (AED only)
• Obtain the Crash Cart/AED
• Remove extra furniture from the room
• Unit Secretary will
• Page Chaplain for Family support
• Call attending MD
• Chart to Room

7
Code Team Their Roles

• Intensivist team leader intubation, gives
  orders
• Critical Care Nurse pushes meds
• Supervisor / Staff nurse documents
• Respiratory therapist assists respirations,
  draws blood gases
• NA CPR, place AED pads, bring cart / chart,
  assist with taking family to quiet location, help
  with other patients
• Student CPR, observation

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Once the code team arrives

• Do not stop CPR when the first team member
  arrives
• Continue until someone is ready to take over
• Defibrillation requires electrical safety
  measures --- everyone OFF the bed including your
  scrub jacket!

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What the Code Team Needs to Know

• Current Diagnosis / Recent Treatments or
  Procedures
• Events Leading Up to Code
• Recent Meds
• Primary MD
• Code Status
• Other Pertinent History Allergies, MRSA Status,
  Diabetic, Cardiac, respiratory history, etc.

10
Post Code Responsibilities

• Patients nurse gives report to
• receiving nurse
• Family Care
• Code Summary printed
• EKG Strips charted
• Completed Code Sheet signed by physician in
  charge of the code
• Code Evaluation completed and sent to Risk
  Management
• Cart Exchange
• Documentation

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Documentation

• Patient assessment
• ECG rhythm (strip)
• Notification of MD, orders received
• Treatments initiated patient response, post
  treatment rhythm (strip)
• If transferred, mode of transport, transfer note,
  receiving unit bed number, receiving nurse

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Students Role in a Code

• Assessment / reassessment
• Notify nurse immediately of changes in the
  patients status
• Perform CPR
• Observe during the Code
• Help with patients family