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

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

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

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