code blue team

8/2/2019 Code Blue Team

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Key Components of ACLS:

1. CPR: the most vital component-involves keeping oxygen pumping into the lungs and

circulating, so the brain and vital organs continue tofunction.

2. Intubation : includes ET placement; IV insertion,

chest tube insertion, etc.

3. Defibrillation:when the initial rhythm of the patientis VF or pulseless VT


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Considerations:

y An extension of BLS

y The team leader analyzes the patients rhythm manually.

y

The team leader gives the shock when needed andorders medications as deemed necessary.

y Chest compressions must continually be applied withminimal to no interruptions.

y Possible causes of the arrest are sought after initialresuscitation; and targeted/ specialized treatment isinitiated.


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y What is an RRT?

y

Designated group of healthcare clinicianswho can be assembled quickly to delivercritical care expertise in response to graveclinical deterioration of a patient outside a

critical care unit.


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yStaff Positions

y Physician : senior resident or

intensivist or hospitalistyPhysicians assistant

yCritical care RN

yClinical nurse specialistyRespiratory Therapist


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y When Does The RRT Respond?

y Hospital sets criteria that a patients

conditionis deteriorating.y May be called for physiologic changes in HR,

SBP, RR, Pulse O2 saturation, mental statusand urinary output.

y May also be called when the nurse has a gutfeeling that something is not right.


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y When Does The RRT Respond?

y Staff nurse activates the team

y Members respond quickly often within 5 mins!y Goal: treat warning signs early to improve

patient outcomes and prevent cardiac arrest

y It has been shown that 2/3 of patients showevidence of identifiable signs ofdeterioration within 6-8 hours of arrest.


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y The Role of the RRT

y Assists the staff member in assessing and

stabilizing the patient condition.y Assists the staff member in organizing information to be

communicated to the patients physician.

y Educates and supports the staff as they care for thepatient.

y If circumstances warrant, assists with patient transfer toa higher level of care.


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y The Role of the RRTy Does not intend to replace the care provided

for by the patients physician.

y

The person who calls the RRT should become a keymember of the team and assist the RRT.

y The team should be trained to communicate and receivecommunication using the SBAR Format (Situation,Background, Assessment, Recommendation)

y Team members should be professional and friendly,provides non-punitive feedback to the person thatinitiated the call.


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y RRT Documentation

y Structured documentation

y

Can be a form that captures and organize informationabout the patients condition prior to activation of theteam, and interventions required.

y Can be used to analyze responses and plan qualityimprovement activities where needed.

y Can also serve as a base for staff education.


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y Why document a CODE event?

y Records all the interventions that occur during aresuscitation

y Benefits:y Provides information that can guide continuing patient care.

y Helps to answer questions that the family may have regardingthe event.

y Assists the institution to know if resuscitation care has beenprovided according to current standards.


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y Why document a CODE event?

y Benefits:y Identifies quality issues so they can be

investigated in a timely manner and to identifyvariances of concerns.y To evaluate whether standards are being met.y Guides in resource allocation as to personnel,

equipment and supplies used duringresuscitations.

y Identify learning needs of staff.y Provide data to answer research questions.y Reduce the risk of medical litigation.


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What Data Elements Should be Tracked forResuscitation Events?

y 3 categories:y Patient variables: age, gender, witness status, location of

event, date and time of event, co-morbid conditions.

y Event Variables: initial rhythm, essential interventions, eventtimes

y

Outcome variables: return of spontaneous circulation (for atleast 20 mins), discharge alive from the hospital, length ofstay, neurologic status, etc.


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What Data Elements Should be Tracked forResuscitation Events?

y Critical time elements should also be documented:

yTime from collapse to the beginning of CPR

yTime from collapse to the first defibrillation(when initial rhythm is VF or pulseless VT)

yTime from collapse to the first dose ofepinephrine.


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Challenges of Good Documentation During a CODE:

y At times, it is not clear if a CPR record should becompleted.

y Code documentation does not start when the patient isfound in arrest but rather begins sometime later duringthe resuscitation.

y The CPR record cannot be quickly found to begindocumentation.


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y The least experienced staff member present at code isasked to document.

y The person documenting is unfamiliar with the CPRrecord and data requested.

y Several different clocks are used to enter times into theCPR record.


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y The data on the CPR record is incomplete.

y The data on the record is illegible.

y The names of all CPR members are not present on theCPR record.

y The CPR record does not reach the committee forreview.


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Additional considerations:

y Trained individuals as documenters.y Documenter should have no other role during the code.y Documenter should have a designated position around

the patients bed.y Summary information should always be obtained from

the defibrillator and a method determined for how tomake it a permanent part of the patients record.

y Original paper CPR should be placed in the patientsmedical record and a copy submitted to the CPRcommittee.


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EVALUATING RESUSCITATION QUALITY

y The goal of a hospitals resuscitation program is to

have in place processes of care to respond to medicalemergencies in a timely, effective manner that leads togood patient outcomes.


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Elements of Good Resuscitation Care in a hospital:

y Policies, procedures, processes and protocols thatgovern the provision of resuscitation services.

y

Resuscitation equipments strategically located that isappropriate to the patient population.

y Appropriate staff who are trained and competent torecognize the patient in hemodynamic distress and todeliver emergency care.

y Good documentation is essential to quality evaluation.


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y Care can be measured both concurrently duringresuscitations and retrospectively.

y The Team Leader can monitor CPR performance, sincemaintaining standards of performance and coachingare within his/her expected role.

y The designated leader participate in a hands- offmanner so that he can monitor the larger scene andguide the team.


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y Other care providers who may carry a CPR team pager:y

cardiac clinical nurse specialisty ED physician

y critical care physician

y the chair person or a member of the CPR Committee.


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y Critical incident debriefing may immediately follow codes.

y The original copy of the CPR record should be placed in thepatients medical record and a copy sent to the CPRcommittee for quality review.

y All quality feedbacks should be set up so that it getsreturned to the designated review group and is protected

from legal discovery according to state quality assurancestatutes.


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EVALUATING RESUSCITATION QUALITYy Aquality review form may be designed by the

hospital with the following categories as headings:

y Notification/pagingy Arrival of team - Team functiony Airway management - Defibrillationy Chest compressions - Protocols: ACLS/ PALSy

Medications - Safety precautionsy Vascular access - Documentationy Equipment


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Factors that should be evaluated from the CPRrecord:y WereACLS/PALS algorithms followed?

y Were the Gold standard Process variables

established by the AHAmet?y Time from collapse to initiation of compressions was


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Factors that should be evaluated from the CPRrecord:y Was the documentation on the CPR record sufficient to

meet institutional standards?y Are the CPR team members current in required

emergency certifications?

y Written feedback should be given in a timelymanner to those participating in the code, to theinitial responders and advanced care responders.y Was the documentation on the CPR record sufficient to

meet institutional standards?y Are the CPR team members current in required

emergency certifications?


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Astitch in time saves nine.

Brain is Life and Time is Brain;

Hence Time is Life.

Therefore time lost maybe equal to a Life or a Brainlost!!!

EVERY MILLISECOND COUNTS!!!


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y Team leader/intubationist

y Recorder/timer

y Medicine nurse

y Defibrillator/Cardiac monitory Intubationist

y IV therapist

y Traffic control/equipment in-charge

y CPR/compressor

y bagger


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y X-ray personnel (optional)

y Laboratory tech./ RT (optional)


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