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Roles of the Medical and Nursing Staff
During Emergency Codes
Mr. Joven Botin Bilbao
Deputy Chief Nursing Officer
Al Hayat National Hospital
CODE BLUE TEAM
 Trained patient care providers who perform
resuscitation on any person who sustains
 Cardiopulmonary arrest
 Respiratory arrest
 Airway problem
 Train providers:
 Doctor
 Nurse
 respiratory Therapist
 Support Personnel
CODE BLUE ACTIVATION
 All employees must be educated to activate Code
Blue response in the event of
 Cardiac arrest
 Respiratory arrest
 Activate Code Blue Response by
 Calling Hospital Emergency Operator
 Provide Information: Patient location, Adult/Pediatric/Obgyne
 Hospital Emergency Operator will activate
response when notified of Code Blue event
 Announce overhead the location of the code event
Example: attention! Code Blue, ER, Pedia ( 3 times )
CODE BLUE MEMBERS
 Physician
 Intensivist, Anesthesia
 Cardiologist/Internal Medicine
 Pediatric attending or senior resident
(Pedia patient)
 Obgyne Attending or Senior resident
(Obgyne/pregnant Patient)
 Nurse
 Intensive Care Unit Nurse
 Emergency Nurse
 Unit Nurse
 Nurse Supervisor
 Respiratory Therapist
 Security Guard
Requirements for the
member of the Code Blue
Team
 Resuscitative Certification
 Advance Cardiac Life Support (ACLS) for
adult code blue
 Pediatric Advance Life Support (PALS) for
pediatric code blue
 Neonatal Resuscitation Program (NRP)
For neonatal code blue
ROLE OF THE TEAM MEMBERS
PHYSICIAN
 Team Leader: direct overall patient care
 Manage the Code
 Medication
 Defibrillation
 Other procedures: Intubation, compressions
 Evaluate Code Blue procedures
 Effectiveness of Chest Compression
 Effectiveness of assisted respirations
 Rhythm/pulse check
 Document in the medical record
ROLE OF THE TEAM MEMBERS
ICU/ER NURSE
 Maintains airway/oxygenation/ventilation
 Applies monitor leads/defibrillator pads
 Starts Intravenous access
 Administer medications
 Administers Electrical Shock (ACLS trained)
 Assist with intubation procedures
ROLE OF THE TEAM MEMBERS
PRIMARY NURSE
 Activate code blue team
 Bring Emergency Resuscitation Cart
 Place backboard under patient
 Initiate 2 man Cardio Pulmonary Resuscitation
 Administer ventilations with 100% O2 with Bag/valve/mask
 Attach Electro cardiogram leads
 Attach “hands off” defibrillator pads
 Ensure patient Intra Venous access
 Prepare suction
 Obtain supplies from CPR Cart/Ward Stock
ROLE OF THE TEAM MEMBERS
NURSE SUPERVISOR
 Record events on CPR record
 Completes CPR record
 Assign additional nurse if necessary
 Arrange for possible transfer to Critical care Unit
ROLE OF THE TEAM MEMBERS
RESPIRATORY THERAPIST
 Maintains airway and oxygenation/ventilation
 Assist with intubation procedures
 Limit the audience and crowd control
during the event of code blue.
ROLE OF THE TEAM MEMBERS
SECURITY GUARD
Rapid Response Team (RRT
 Rapid Response Teams is a designated group of healthcare clinicians
who can be assembled quickly to deliver critical care expertise in
response to grave clinical deterioration of a patient located outside a
critical care unit.
 RRTs provide early recognition & response to signs of patient's
deterioration
Goals of RRT
 To save patient lives & eventually improve quality of
hospital care & improve patient safety
 Increase early intervention & stabilization to prevent
clinical deterioration on any individual prior to the event
of cardiopulmonary arrest or other life threatening
health event
 Decrease the number of cardiopulmonary arrests that
occur outside the ICU & ER department
 Increase patient, family & staff satisfaction
 Decrease hospital mortality rate
 Reduce severe postoperative adverse events
RRT Member
 Primary nurse (who activated RRT)
 ICU nurse (ACLS for adult) (PALS for
pedia)
 Nursing supervisor on duty
 Respiratory therapist
 Intensivist resident on duty
 Pediatric specialist on duty
Key features of the RRT
There are three key features of the team
members:
 They must be available to respond immediately
when called, and not be constrained by
competing responsibilities
 They must be onsite and accessible
 They must have the critical care skills necessary
to assess and respond
How to activate RRT ?
 Attending nurse / doctor dials 0 and connect to
the supervisor on duty.
 Supervisor will contact the member of the Rapid
response Team
 Five minutes is the response time for the group
to arrive, 15 minutes is the maximum time for
the team arrival
Role of unit nurse in RRT
 Assesses patient, check vital signs
 Identifies crisis, refer patient’s condition
following SBAR guidelines
 Call for help
 Stays with the patient
 Helps patient into comfortable position
 Shares pertinent information with RRT
members upon their arrival
 Bring crash cart to the site
Role of Nursing Supervisor
 Responds immediately to request for activation of the
rapid response and coordinate with the member of the
RRT team.
 Assess situation especially with regards to activities of
nursing staff & provides additional assistance if needed
 Calls relevant consultants as requested by Code purple
team leader
 Coordinated transfer of patient to ICU if the need arises
 Undertakes recording & documentation
Role of ICU nurse
 Responds to assist ICU resident on duty / ICU
Specialist on duty to provide care needed.
 Prepares inotropes as needed to transfuse
with infusion pump.
 Monitor the patient until stable and
accompany patient for transfer to the critical
area.
Role of Respiratory therapist
 Assists the ICU resident / Specialist in
managing airway
 Provides portable ventilator from ICU if
the need arises
 Assists in transferring of the patient to ICU
Role of ICU resident on duty
 Assess the clinical condition of the patient
 Stabilize the patient’s condition
 Provides airway management, maintains oxygenation
 Provides ventilation manually or by the use of portable ventilator
 Assists in transfer to ICU if needed
 Assists in inter-hospital transfer if needed
 Assist with the mobilization of resources required to further
support the patient
 Decides about the transfer of patient to higher level of care
 Educates & support nursing & medical staff
 Conducts a debriefing session after the RRT for the team

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Roles of the medical and nursing staff during emergency codes

  • 1. Roles of the Medical and Nursing Staff During Emergency Codes Mr. Joven Botin Bilbao Deputy Chief Nursing Officer Al Hayat National Hospital
  • 2.
  • 3. CODE BLUE TEAM  Trained patient care providers who perform resuscitation on any person who sustains  Cardiopulmonary arrest  Respiratory arrest  Airway problem  Train providers:  Doctor  Nurse  respiratory Therapist  Support Personnel
  • 4. CODE BLUE ACTIVATION  All employees must be educated to activate Code Blue response in the event of  Cardiac arrest  Respiratory arrest  Activate Code Blue Response by  Calling Hospital Emergency Operator  Provide Information: Patient location, Adult/Pediatric/Obgyne  Hospital Emergency Operator will activate response when notified of Code Blue event  Announce overhead the location of the code event Example: attention! Code Blue, ER, Pedia ( 3 times )
  • 5. CODE BLUE MEMBERS  Physician  Intensivist, Anesthesia  Cardiologist/Internal Medicine  Pediatric attending or senior resident (Pedia patient)  Obgyne Attending or Senior resident (Obgyne/pregnant Patient)  Nurse  Intensive Care Unit Nurse  Emergency Nurse  Unit Nurse  Nurse Supervisor  Respiratory Therapist  Security Guard
  • 6. Requirements for the member of the Code Blue Team  Resuscitative Certification  Advance Cardiac Life Support (ACLS) for adult code blue  Pediatric Advance Life Support (PALS) for pediatric code blue  Neonatal Resuscitation Program (NRP) For neonatal code blue
  • 7. ROLE OF THE TEAM MEMBERS PHYSICIAN  Team Leader: direct overall patient care  Manage the Code  Medication  Defibrillation  Other procedures: Intubation, compressions  Evaluate Code Blue procedures  Effectiveness of Chest Compression  Effectiveness of assisted respirations  Rhythm/pulse check  Document in the medical record
  • 8. ROLE OF THE TEAM MEMBERS ICU/ER NURSE  Maintains airway/oxygenation/ventilation  Applies monitor leads/defibrillator pads  Starts Intravenous access  Administer medications  Administers Electrical Shock (ACLS trained)  Assist with intubation procedures
  • 9. ROLE OF THE TEAM MEMBERS PRIMARY NURSE  Activate code blue team  Bring Emergency Resuscitation Cart  Place backboard under patient  Initiate 2 man Cardio Pulmonary Resuscitation  Administer ventilations with 100% O2 with Bag/valve/mask  Attach Electro cardiogram leads  Attach “hands off” defibrillator pads  Ensure patient Intra Venous access  Prepare suction  Obtain supplies from CPR Cart/Ward Stock
  • 10. ROLE OF THE TEAM MEMBERS NURSE SUPERVISOR  Record events on CPR record  Completes CPR record  Assign additional nurse if necessary  Arrange for possible transfer to Critical care Unit
  • 11. ROLE OF THE TEAM MEMBERS RESPIRATORY THERAPIST  Maintains airway and oxygenation/ventilation  Assist with intubation procedures  Limit the audience and crowd control during the event of code blue. ROLE OF THE TEAM MEMBERS SECURITY GUARD
  • 12.
  • 13. Rapid Response Team (RRT  Rapid Response Teams is a designated group of healthcare clinicians who can be assembled quickly to deliver critical care expertise in response to grave clinical deterioration of a patient located outside a critical care unit.  RRTs provide early recognition & response to signs of patient's deterioration
  • 14. Goals of RRT  To save patient lives & eventually improve quality of hospital care & improve patient safety  Increase early intervention & stabilization to prevent clinical deterioration on any individual prior to the event of cardiopulmonary arrest or other life threatening health event  Decrease the number of cardiopulmonary arrests that occur outside the ICU & ER department  Increase patient, family & staff satisfaction  Decrease hospital mortality rate  Reduce severe postoperative adverse events
  • 15. RRT Member  Primary nurse (who activated RRT)  ICU nurse (ACLS for adult) (PALS for pedia)  Nursing supervisor on duty  Respiratory therapist  Intensivist resident on duty  Pediatric specialist on duty
  • 16. Key features of the RRT There are three key features of the team members:  They must be available to respond immediately when called, and not be constrained by competing responsibilities  They must be onsite and accessible  They must have the critical care skills necessary to assess and respond
  • 17.
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  • 21. How to activate RRT ?  Attending nurse / doctor dials 0 and connect to the supervisor on duty.  Supervisor will contact the member of the Rapid response Team  Five minutes is the response time for the group to arrive, 15 minutes is the maximum time for the team arrival
  • 22. Role of unit nurse in RRT  Assesses patient, check vital signs  Identifies crisis, refer patient’s condition following SBAR guidelines  Call for help  Stays with the patient  Helps patient into comfortable position  Shares pertinent information with RRT members upon their arrival  Bring crash cart to the site
  • 23. Role of Nursing Supervisor  Responds immediately to request for activation of the rapid response and coordinate with the member of the RRT team.  Assess situation especially with regards to activities of nursing staff & provides additional assistance if needed  Calls relevant consultants as requested by Code purple team leader  Coordinated transfer of patient to ICU if the need arises  Undertakes recording & documentation
  • 24. Role of ICU nurse  Responds to assist ICU resident on duty / ICU Specialist on duty to provide care needed.  Prepares inotropes as needed to transfuse with infusion pump.  Monitor the patient until stable and accompany patient for transfer to the critical area.
  • 25. Role of Respiratory therapist  Assists the ICU resident / Specialist in managing airway  Provides portable ventilator from ICU if the need arises  Assists in transferring of the patient to ICU
  • 26. Role of ICU resident on duty  Assess the clinical condition of the patient  Stabilize the patient’s condition  Provides airway management, maintains oxygenation  Provides ventilation manually or by the use of portable ventilator  Assists in transfer to ICU if needed  Assists in inter-hospital transfer if needed  Assist with the mobilization of resources required to further support the patient  Decides about the transfer of patient to higher level of care  Educates & support nursing & medical staff  Conducts a debriefing session after the RRT for the team