Code blue is perhaps the most popular
codes used in hospital for managing emergency situation. Code blue is a code
given to identify and communicate that a medical emergency, of the nature of
cardiac arrest, has occurred and the patient needs to be attended immediately
for life saving measures. (Other codes - Code Pink, Code Red). Since it deals with the life threatening situation, swift
and coordinated action by a team of professionals is of paramount importance. This
calls for designing and implementing a highly efficient system, which can work
in round the clock and can cover entire hospital. This posts elaborate on all considerations
that should be made while designing a code blue system. Also check code blue form and crash cart checklist along-with this post.
1.
Forming
of a code blue team: The code blue team is at the core of entire system.
This is a team of trained professionals who can competently provide life saving
measures to a patient under medical emergency. Following are the roles required
within the team with a suggested person who could be given that role. Hospitals
can however, modify this as per their staffing structure and hospital’s layout
Role
|
Who
can perform
|
Calling (activating) the code
|
This can be any one who identifies the
situation and activates the code blue. As it could be any healthcare staff
they are not a part of code blue team
|
Initial action before the code blue
team reaches on the spot – This includes bringing patient’s medical record, bring
the crash cart trolley, positioning the patient and start with CPR
|
This can be done by the caller of the
code along with other secondary nurse available in the area. (In a hospital
all nurses and healthcare staff should be trained on basic life support and
CPR)
|
Airway management, bag mask ventilation,
suctioning of the airway and assistance to anaesthesia in case of intubation
|
A doctor, preferably from ICU or
anaesthesia department
|
Application of defibrillator pads, ensuring
proper position of the patient
|
Nurse 1 (preferably from critical care
department). This person can also be given role of recording the events for
future analysis.
|
Continuation of CPR measures, use of
defibrillator, conducting anaesthesia or intubation if required.
|
A doctor, preferably from anaesthesia
department
|
Preparation and handing over
medication from the cart
|
Nurse 2
|
Putting in IV and administering
medication received from crash cart
|
Nurse 3
|
Leading the team, taking quick
decisions, manage situation and help with defibrillator, anaesthesia and
intubation part
|
Team leader – generally a physician
from critical care or emergency department
|
* The team members should be
identified and they should be communicated about their roles during code blue.
* The team should consist of
at-least 5 members to effectively handle critical functions
* At-least one member in the team
should be certified in ACLS. All members in team should be trained in BLS.
2.
Number of
code blue teams – Since the code blue team is required round the clock, the
number of teams should be at-least 3 to cater for in each shift. In case of
large hospitals, multiple teams can be formed with their specified coverage
area
3.
Communication
of code – One essential objective of code blue system is to ensure that
every code blue team member should immediately get to know about the occurrence
of the medical emergency. There are several ways in which this could be done
a.
Calling
number and announcement: In this there is a dedicated internal telephone
number (like 1111 or 99) which is used only for informing code blue. The number
when dialled rings at telephone operator (or a dedicated place with round the
clock presence of a person who will receive the call). The instrument that
receives the call from dedicated number is exclusive and will never be busy
with any other line. A standard statement is used for communicating code blue,
such as ‘Code blue – ward no. 22’. The receiver of the call (the telephone
operator) also has a public announcement system. As soon as he receives a code
blue call, he announces the same in public announcement system and all code
blue team members, wherever they are working, get to know about the code. As
soon as they here the announcement they immediately move towards the location
and perform their role. One objective of code blue system is to ensure that code
blue team reach the point of event quickly (within 1 minute) of .
b.
Pager system:
In this all code blue team members on duty carries a pager. There is a dedicated
telephone number as explained above. Instead of making a public announcement
the receiver of code blue call just page it to all team members at one go. The
pager beeps indicating to holder that a code has been called
c.
Push
button switch: In this, a code blue switch is installed in each patient
area. The switch when pressed sends an indication to all code blue team member
about the location where the emergency has occurred
4.
Crash
cart – Crash cart is a trolley that consist of all necessary medicines, equipment
and instruments that may be required for carrying out BLS and ACLS measures. Clickhere to get the list of items in crash cart and other requirements related toits management
5.
Trainings
– There are two types of training that is required. One for the code blue team
members and one for all healthcare staff in the hospitals
a.
For code blue team – The code blue team should
be trained on following
i.
Orientation to code blue system
ii.
The communication system under code blue
iv.
Basic life support techniques, including CPR
v.
At-least one member to be trained and certified
in Advanced Life Support technique
b.
For all other staff
i.
Orientation to code blue system
ii.
When and how to activate code blue
iii.
Basic Life support including CPR
6. Mock drill: Since code blue requires a
highly coordinated activity mock drill of code blue should be done regularly to
ensure that the system is functioning. For mock drill, a nurse assume that a
patient has collapsed and activates code blue. An observer is placed to observe
and record everything that happens on activation on code. The observations are
then reviewed to identify if every thing happened as planned or whether there
was deviation. Based on mock drill findings, necessary training are provided
7. Documentation of code blue event – It is
important to document critical actions and happenings during the code blue
event. These records are used for multiple purpose, including doing a
post-event analysis. One of the team member take the role of the recorder. A standard form that captures necessary data should be used for documenting each code blue
event.
8. Post event analysis: A post event
analysis should be done for each code blue event to assess if everything
required was done and if there were any major or minor deviations from the code
blue protocol
9. Quality indicators: Few indicators that
can be used for evaluating whether or not the code blue system is working
efficiently and effectively, are given below
a. Average time to respond – The time from
activation of code blue till the time when the 1st member of code
blue team reach on spot
b. Outcome percentage – Percentage of
patients’ survived out of total who went under cardiac arrest
c. Non- compliance rate – Percentage of
non-compliance to standard process of code blue system
d. Failure to activate – Percentage of
times when code blue was not activated, when required
