TRMC Clinical Module Code Blue / Rapid Response Documentation and More

1. TRMC Clinical Module Code Blue / Rapid Response Documentation and More

2. PowerPoint This module is viewed in PowerPoint. For maximum viewing, click on the slide show “indicator” on the toolbar directly below this slide (to the left of the percentages for the Zoom Bar). Once clicked, press enter to advance the slides and backspace to go back. Enjoy!

3. Introduction Welcome to the learning module on Code Blue / Rapid Response Documentation and More. This module concentrates on a review of the Code Blue Record but also includes a reminder of all Code Blue Team duties and Rapid Response actions. Knowledge of resuscitation is key to survival of the patient and providing thorough documentation.

4. Description of the Course • This course is designed to refresh the nurse’s knowledge of recognizing an emergent event, appropriate interventions and accurate documentation. The module includes policy / procedure review and a post-test. • This module is recommend for RNs and LVNs assigned to the Code Blue Team (Recorder, Medication Nurse, Patient Charge Nurse, etc.) • This module was prepared by: Carol Bradford, BSN, RN, Staff Educator and The Professional Development Team.

5. Learning Objectives By the end of the module the learner will be able to: • List duties of the Code Blue Team. • Recognize signs and symptoms of a Rapid Response (RRT) vs. a Code Blue (CB) situation and activate the appropriate announcement. • Demonstrate proper documentation during a Code Blue.

6. Code Blue (Adult) and Code White (Pediatric): Cardiopulmonary Resuscitation (Disaster)Policy 21-2002 • Review the hospital policy #21-2002 found on the hospital Intranet under “Hospital Policies” • The following slides include key parts of the policy.

7. Code Blue Team Code Blue Response: • Respiratory Therapist • Pharmacist (during pharmacy hours) • Medication Nurse (ICU or ED ACLS RN) • Recorder • Cardiac Massage • Supervisor/Designee • Physician • Charge nurse for the patient • Other appropriate personnel The Nursing Supervisor will designate and post code team roles at the end of each shift for the oncoming shift.

8. Recognize Code Blue Event • Note the time and immediately dial ’77’ on the nearest phone, inform operator of location. • Check for responsiveness, recognize patient as non-breathing, check carotid pulse for 5-10 seconds. • If pulse is present provide rescue breaths one every 5-6 seconds (adults), one every 3-5 seconds (child). • If no pulse, insert back board and start closed chest cardiac massage; 30 compressions, 2 ventilations. Continue until help arrives (continue with 30:2 ratio for one and two rescuer adult; or 30:2 one rescuer, 15:2 two rescuer child).

9. Code Blue Team Duties: • Unit Secretary to bring chart to the room, call physician as directed. • RN in charge of patient directs activity until team arrives, responds to questions from code team, works with team to resuscitate the patient, communicates with patient’s family and is responsible for final documentation. • Medication Nurse (ACLS certified RN from the ICU or ED), assures IV line is established, administers medication per ACLS guidelines or under direction of physician. Repeats the dosage to the recorder, checks monitor for rhythm, mounts cardiac rhythm strips from code, reviews and signs the Code Blue record. An ACLS certified RN is in charge of the code in the event the physician is delayed.

10. Code Blue Team Duties continued: • Supervisor or Designee coordinates activities, assures excessive personnel leave the code, assures the crash cart exchange is implemented post code, reviews the code blue documentation, competes and/or adds comments to the Code Blue Critique form. • Pharmacist to prepare medications and provide medication information. • Respiratory Therapist to manage airway, perform ABG and/or EKG if needed. • Unit Personnel assist with CPR, ensure crash cart arrives in room, available to go for supplies, resume normal duties when code team arrives. • PBX will announce “Code Blue” (adult) or “Code White” (pediatric) and the room number 3 times. PBX will also page the Nursing Supervisor, Patient and Family Services, RT, and Security. • The ED physician will respond to every Code Blue. Any physician physically in the hospital shall also respond.

11. Code White Pediatrics: • Use the Broselow tape for children (3-36 kg and 25”-48”). Broselow tape can be found on any Broselow Cart in areas where TRMC employees care for Pediatric Patients (ED, ACU, OR, PACU, Pediatrics). • Measure children on admission and place the correct (Broselow) color coded wristband on child. • The correct equipment for a Code White is in the Broselow Cart. • A PALS certified RN will fill the role of Medication Nurse during a Code White. A PALS Certified RN will team lead if the physician is delayed.

12. Documentation Recorder: • Completes Code Blue Record. • Records all interventions during Code Blue – medications, intubation, IV solution, defibrillation, if ResQPod is used, any patient response, etc. • Communication is needed between Recorder and Medication Nurse. Recorder repeats dosages and times for clarity. • Assists in time keeping for purposes of repeating medication dosages (example: Epinephrine given every 3-5 minutes). • Recorder and/or Supervisor will document on the Code Blue Critique (blue sheet) any issues occurring during the code. • All participants sign Code Blue Record after code completion.

13. Code Blue Record

14. Code Blue Record continued

15. Code Blue Record continued

16. Code Blue Critique The Recorder and/or the Nursing Supervisor will document any comments on the Code Blue Critique form. This is the opportunity to comment on Code Team performance, equipment malfunctions, restocking issues, if too many staff are in the room, or make recommendations for improvement. The Code Blue Committee reviews all comments made on the critique.

17. Documentation Top Tips Key Points: • Make sure patient ID is on Code Blue Record. • Get signatures of all code participants. • If the laryngoscope bulb is out (or any other equipment malfunction) document on the Code Blue Critique Form. • Don’t forget to document IV lines (in place and started during code) and intubation either infield or during code. • If you don’t know the ED Physician ask someone on the code team. • The original white record goes in the patient’s chart, yellow copy goes with the crash cart to Central Processing, pink copy goes to the Code Blue Committee (slot in mail room).

18. Rapid Response TeamPolicy 12-3076 • Review the hospital policy #12-3076 found on the hospital Intranet under “Hospital Policies” • The following slides include key parts of the policy.

19. Criteria for Calling Rapid Response: • Staff Member is worried about the patient. • Acute change in HR <40 or >130 bpm • Acute change in systolic BP <90 mmHg • Acute change in Respiratory rate <8 or > 28 per minute • Acute change in Breath Sounds (wheezing, stridor etc.) • Acute change in O2 Sat <90% despite oxygen • Acute change in Temperature • Acute change in level of consciousness • Acute change in blood sugar • Acute change in urine output <50ml in 4 hours • Acute changes in cardiac rhythm or 12 lead EKG • Acute, significant bleed • Chest pain

20. Rapid Response Key Points: • Dial ‘77’ to inform operator of a “Rapid Response Team (RRT) call”. • RRT response includes – the patient’s nurse, ACLS certified Critical Care RN (ED and ICU), Nursing Supervisor or Designee, Respiratory Therapist, Pharmacist, and Emergency Department Physician and/or Hospitalist (optional). • If at anytime the patient becomes breathless or pulseless a Code Blue shall be called. • The RRT will work collaboratively with the patient’s nurse to stabilize, update physician, and facilitate a transfer to higher level of care if needed.

21. Rapid Response Documentation The RRT will complete the Rapid Response Team Record. Be sure to document patient ID information and interventions by the RRT. The original form goes in the patient’s chart, yellow copy goes to ICU Director.

22. Conclusion Code Blue and Rapid Response: • Dial ‘77’ to inform operator of a “Rapid Response Team” (RRT) call or a “Code Blue” (CB) call. • Respond to all RRT and CB calls in main hospital the same. • For RRT/CB situation in Allied Building, parking lot, hospital lobby, etc. call the code and transport to the Emergency Department as soon as possible. • Emergency Protocol for off campus buildings – Family X-Ray, Evolutions, Clinics etc. dial 911 for any person exhibiting S/S of distress or signs of cardiac arrest. AED and CPR shall be initiated by trained staff until arrival of EMS.

23. Thank you for Reviewing Code Blue and Rapid Response Documentation and More You may now return to take the test. Good Luck!