1. NEW and Expanded Code Green This is confidential and protected quality improvement information per RCW 4.24.250 and 70.41.200.

2. Objectives • Describe New Code Green • Identify where Code Green is available • Describe how to activate Code Green • Describe what to expect from Code Green This is confidential and protected quality improvement information per RCW 4.24.250 and 70.41.200.

3. Why NEW Code Green? • Many critical care areas (ED, Cath Lab, OR) have most, but not all, providers for a “coding” patient. They do not need a full code blue response. • Need immediate additional resources • Ad-hoc paging can result in delays • House-wide awareness • Ad-hoc paging can miss critical personnel

4. Why NEW Code Green? • Full Code Blue team response can physically overwhelm these critical care areas • Full Code Blue team response pulls many providers, unnecessarily, from their ongoing patient care

5. What is Code Green? • A modified Code Blue response • Includes a subset of the Code Blue Team • Provides additional personnel to existing critical care teams • Activating team should include a physician team leader capable of running a code team

6. Where Code Green will be available Expanding beyond the OR!! • Available in: • OR • ED • PACU • Cardiac Catheterization Lab

7. Which patients qualify for Code Green? A patient in impending or current cardiopulmonary failure or arrest • Acutely Unstable Airway • Respiratory Failure • Circulatory Failure • Acutely Altered Mental Status • At risk for failure of A,B,or C • For high acuity medical emergencies outside of scope

8. Code Green: Activation • Team leader or nurse (if team leader unavailable) decides if Code green needs to be activated • 7-9999- tell to activate Code Green and give specific location • Page will be announced overhead • Page for “Code Green” will be sent to subset of Code Blue Team

9. Activation of Code green ****Know what level of response occurs from activating buttons in rooms (not standard in all parts of hospital) Blue button- activates code blue by signaling telecommunications Red button- in the OR this is for anesthesia assistance (internal call) Green button- staff assistance; NOT an emergency CODE GREEN IS ACTIVATED BY CALLING 7-9999 and giving location

10. Code Green: Who Comes • PICU Fellow • PICU Charge RN • NICU Charge RN • Anesthesia resident • RT • Shift Administrator • PICU Attending • Paged, not always in house

11. Code Green: Response • All Team Members respondSTAT • Initial Critical Care Team responsibilities • Identify selves to Code Green team • Review patient course • Identify how Code Green Team can assist • Code Green Team responsibilities • Dress in surgical jumpsuitif called to OR • Identify self on arrival and discuss role • Help assess, assist current team • Suggest additional considerations • Jointly discuss patient disposition • PICU RN will ask if eligible for eCPR I’m Dr. Roberts, PICU attending. How can I help?

12. Code Green documentation • Documented on Code blue sheet • Form is copied and QI form is completed and copied- given to CNS or manager on unit

13. Code Roles for the OR

14. Code Roles for the PACU

15. Code Roles for Cardiac Catheterization lab

16. Code Roles for the Emergency Department

17. Code Green PDCA • Activations will be reviewed in Code Blue Committee • In the future, simulations will be planned to work on Code Green teamwork between Code Green team members and initiating unit

18. Code Green Summary • Available in ED, OR, PACU, Cath Lab • Critical care team (including physician team leader) already in place, need additional help • Patient in impending/active cardiopulmonary failure • Call 7-9999 with location • STAT response of: • PICU fellow, PICU charge RN, NICU charge RN, Anesthesia, RT, Shift Administrator and PICU attending (if in house)

19. Go-live August 2, 2010 Questions This is confidential and protected quality improvement information per RCW 4.24.250 and 70.41.200.