Code Blue Policy

Code Blue Policy 

Policy

- The hospital has uniform use of resuscitation services through out the organization.

- All Code Blue Team members are called with the emergency number coming on the cell phone detailing the emergency requirement and the bed number.

- Announcement is made over the Public Address System for ‘code blue’. It is announced thrice.

- Trigger for Code Blue: Code blue shall not be called for the following situations:

i.              Patients brought unconscious /without cardiac activity in ER

ii.             Advanced malignancy 

iii.           More than 3 major organ dysfunction 

iv.           Operation Theatres

v.         Recovery room of OT Complexes. However, staff (nurses or doctors) can call the Code whenever desired, for e.g. during off hours or when manpower is not available.

vi.           Hypothermia

vii.          Electrolyte abnormality

viii.         By standard CPR after cardiac arrest

ix.           >20 minutes elapsed since cardiac arrest without CPR

x.            Rhythm – Flat time

- Who can activate a Code Blue?

              ¨ Any staff member can call a Code Blue

- Code Blue Team

· Medical

§  Team Leader – 1 (ACLS trained Doctor)

§  Anaesthetist & Surgical Registrar – for Operation Theatre

§  On duty doctor in Critical Care area

§  Ward – Residents and Floor Coordinators / Registrars. 

· Nursing

§  Team Leader - Code Nurse – 1

§  Staff Nurse attending the patient

§  Ward In charge / Supervisor on duty

· Others

§  House keeping personnel

§  Floor Pharmacist

§  Administrations – Night Manager / Medical Coordinator.

§  Security

-  For Paediatric & NICU:

§  Respective registrars are the Team Leaders.

§  Senior Nurse – 1

§  Code Nurse – 1

§  Housekeeping supervisor and staff of that area

- Code Blue Response:

§  CPR to be started and continued by al available staff till arrival of Code Blue Team

§  Only bag-mask ventilation to be done till arrival of anaesthetist / on instructions of Team Leader /ER physicians.

§  All staff to clear out on arrival of Code Blue Team

- Role of a Senior Nurse:

§  Start recording events in the Code Blue Running Sheet.

§  Ensure availability of Glucometer and BP Apparatus through other nurses

§  Create labels for blood samples

§  Hand over the required medications to the Staff Nurse

§  Dispatch blood samples to lab as required by the Team Leader.

§  Process the Patient for transfer to ICU / Mortuary at the end of Code Blue

- Priority for Code Nurses:

§  Obtain and open Crash cart

§  Hand over laryngoscope and ET tube to anesthetist

§  Administer medications as per Team Leader.

§  Obtain blood sugar level by Glucometer

§  Transfer the patient at the end of the Code Blue.

- Priority for Team leader:

§  Attach defibrillator leads and obtain baseline recording

§  Interpret ECG finding and advise medications accordingly

§  Ask nurse to do Glucometer check

§  Obtain ECG recordings after every 5 minute interval or sooner if there is a change in cardiac rhythm

§  Order Dc shocks, medications, tests as required

§  Confer with Consultants at the end of the Code Blue

§  Write detailed CPR notes and paste ECG recordings in the progress notes at the end of the Code Blue

- Priority for Anaesthetist:

§  Establish airway and breathing

§  Establish venous access if not done so far.

- Residents

§  Start cardiac massage and rotate every 3-5 minutes

§  Start venous access

§  Give Dc shock as advised by team Leader

§  Check vitals as desired by the Team Leader

- Crash Carts:

§  The list of drugs and equipment is compiled by the Code Blue committee and is reviewed as and when required.

§  To be stocked by Pharmacy

§  Detailed monthly checks by Pharmacy

§  Nursing to check seal intact at every shift change.

§  On use of a crash Cart, Pharmacy to be informed immediately

§  Pharmacy shall replace the crash cart with another fresh cart immediately without any delay

§  Pharmacy shall compile the list of drugs and consumables used from the crash cart and bill it directly without the involvement of the nurses.

- Training:                                

     a.    BLS

• All direct care providers (all doctors, nurses, Para-medical)
• Two sessions to be conducted per month
• To be completed within 1 month of joining
• To be taken off the payrolls if not done

     b.    ACLS

·         All doctors in Critical Care Area and Emergency

·         Anaesthesia, Emergency &  Pulmonary Medicine Senior Medical Staff

·         Cannot be Team Leaders if not done (hence, cannot be on call)

c. PALS & NAL

• Paediatric senior 7 junior medical staff
• Anaesthesia physicians (Sr & Jr)
• PICU & NICU nurses

 Procedure

Work instruction to Telephone Operators for Code Blue Situations:

1.    attend call within 2 rings at 111

2.    Keep a pen& code blue note pad near the phone (always)

3.    Following the call – write details

a.    the name of the caller

b.    patient – floor, wing , bed no., name

c.    record time of call

4.    Read back the details quickly and hang the Phone

5.     Announce –

a.    ‘this is a code blue call’ – 3 times

b.    announce patient  at floor, wing 

6.    Hang the P.A. System

7.    Call to all doctors 

8.    Tell about - 

o   the name of the caller

o   Patient – floor, wing, bed no. & name

Repeat announcement every one minute until doctor arrives