Journal Reading

Submitted by: Racquel V. Canono – BSN 4

Submitted to: Mariecar Jill E. Zamora, RN

Topic: “Code blue: Do you know what to do?”

By: Janet E. Jackson, MS, RN, and Amy S. Grugan, MSN, RN

SUMMARY:

Hospital emergency codes are used worldwide to alert staff for various emergency situations in
hospitals. The use of codes is intended to convey essential information quickly with a minimum of
misunderstanding to the hospital staff, while preventing stress or panic among visitors of the hospital.

“Blue code” is generally used to indicate a patient requiring resuscitation or otherwise in need of
immediate medical attention, most often as the result of a respiratory or cardiac arrest. Each hospital, as a
part of a disaster plan, sets a policy to determine which units provide personnel for code coverage. In
theory, any medical professional may respond to a code, but in practice the team makeup is limited to
those who had advanced cardiac life support or other equivalent resuscitation training. Frequently,
physicians from anesthesia, emergency medicine and internal medicine are charged in the team. A rapid
response team leader or a physician is responsible for directing the resuscitation effort and is said to “run
the code”.

Cardiac arrest in hospital areas is common, and delayed treatment is associated with a lower
survival rate. Some hospitals have rapid response teams or “blue code teams” to reduce preventable in-
hospital deaths. Although education about the blue code team program has been provided in all hospitals,
true “blue code” activations are rare. Due to the lack of medical emergency teams (METs) in this country,
it is thought that wrong blue code activations are given by medical personnel in practice.

REACTION / CONCLUSION:

This study is very helpful because we can gain a lot of knowledge from it about Code Blue. This
journal could improve the knowledge, skills, and abilities of health care professionals especially in doing
medical care and interventions. This journal also made me aware of what Code Blue is, and what are the
important things that I should know about it, so that when I am already working in a hospital, hearing the
term Code Blue will not be new to my ears. This also helped me be ready and prepared when times come
that a Code Blue will happen. As a student nurse, if I hear the term Code Blue, I know that this is when a
patient suffers from sudden cardiac or respiratory arrest and needs immediate medical attention, Code
Blue is the medical parlance. In other words, Code Blue is a hospital emergency code that is used in all
hospitals around the world, and every minute is important as the chance of revival decreases with time.
Since I am still a nursing student and haven’t experienced a Code Blue during our duty, I know that
experiencing a Code Blue in a hospital for the first time is one of the most unforgettable experiences of
nurses in their career. That it can be scary for new nurses as it always happens unexpectedly, but once you
go through it, you will feel more confident in facing the tough situations in patient care. I am also aware
that there are trainings provided for nurses so they will be skilled in responding to code blue situations
appropriately. All in all, this journal is very informative and very helpful.

RECOMMENDATIONS:

The role of first responders is critical as they will start the resuscitation efforts to the patient undergoing
cardiopulmonary arrest. Here are the detailed tasks of the first responders to the code based on the
guidelines of the American Heart Association:

• First Responder
– Call for help.
– Ensure patient is flat on bed. Remove pillows and drop the head of bed.
– Check for pulse. The best site for this is the carotid pulse.
– Start compression.
• Second Responder
– Bring the e-cart and other emergency equipment on the site of code.
– Secure the backboard under the patient.
– Manage airway by using an ambu bag or a pocket mask with one-way valve.
– Switch role with the first responder in giving chest compressions to the patient.
• Third Responder
– Turn on the AED/defibrillator and use it for pulseless patients.
• Fourth Responder
– Ensure that IV fluids and emergency medications are ready for use of the Code Team.
• Fifth Responder
– In-charge with documentation.

Hospitals have different code team members but it is usually composed of the following:

• Physician
– Serves as the code team leader
– Directs medical management to be followed by the rest of the Code Team
• Unit RN
– Assists the Code Team as needed
– Initiates basic life support.
• Critical Care/ICU RN
– Serves as the code team leader until the physician arrives
– Manages and monitors defibrillator and cardiac rhythm strips
– Relays ECG findings to the physician and to the nurse documenting the code
– Administers emergency drugs as directed
 • Pharmacist
– Prepares emergency medications
– Calculates infusion rates
– Ensures drug incompatibilities are avoided
– Ensures the e-cart is properly restocked
• Respiratory Therapist
– In-charge of airway management and respiratory assessment
– Assists in intubation
– Secures settings of mechanical ventilator
– Obtains and reports arterial blood gases as ordered
• Clinical Supervisor
– Facilitates communication between the physician and the patient’s family
– Assists patient’s family in the waiting area as the code progresses
– Facilitates transfer of patient to a critical care unit once revived
– Assists nurse in documentation to ensure proper recording of the events that took place.
• ED Techs
– Performs chest compressions
– May serve as runner of the team
– Assists in the transfer of patient to the critical care unit once revived

Aside from the medical team, the following personnel are also important during code blue in hospital:

• Security
– Assists with crowd control
– Ensures patient’s belongings are secured during the code
– Facilitates post-mortem transfer of patient’s body to the morgue if the patient will expire
• Pastoral Services
– Provides emotional and spiritual support to the patient’s family
– Facilitates communication with the patient’s spiritual or religious affiliates

Do’s:

1. Get involved – Be active with the code team even if it’s your first time to be involved. It’s a rare
opportunity to be involved in an ongoing Code Blue and you can gain valuable experience as a
nurse.
2. Participate in mock codes – Healthcare institutions usually conduct mock codes especially for
new nurses so they will be oriented with the hospital’s policies during Code Blue. You will learn
all the essential do’s and don’ts by participating with these mock codes.
3. After your first Code Blue, debrief with the team afterwards – Talk with the team about the
things that went well and what areas need improvement. Debriefing after the code will help you
improve your skills and knowledge in responding to codes.

Don’ts:
 1. Leaving the code right away – Once the Code Team has arrived, don’t leave the scene right
away. You know your patient well and the team might need some information from you as the
patient’s charge nurse.
2. Switching roles without proper communication – If you feel the need to switch roles,
communicate with the team to ensure someone will take place of your role.
3. Shouting – Be calm and communicate clearly. Do not shout or yell as it adds up to the tension of
the team during a code. Speaking calmly also maintains your presence of mind throughout the
event.

Here are some medications that may rescue the patient:

• Epinephrine is a medicine often used for patients suffering from cardiac arrest.
• Naloxone is a medicine used to help patients suffering from respiratory depression.
• Atropine is another common medicine used in cases of symptomatic sinus bradycardia.

Patients with DNR Orders:

• In potential code blue situations, patients with do-not-resuscitate (DNR) orders are a different
case. When you are handling a DNR patient with cardiac or respiratory arrest, you don’t need to
perform the recommended measures or call code blue. The reason is, these patients have legal
orders stating that they do not wish to receive any kind of cardiopulmonary resuscitation (CPR)
or advanced cardiac life support (ACLS). So nurses and other medical professionals know that
specific patients are DNR, these patients wear DNR-marked wristbands. Hospitals also keep
DNR orders in patient charts so that it is clear to the professionals treating them.