Duties
A Code Blue is a term used to define "a medical or
surgical emergency which constitutes an immediate
threat to the life of an
individual..." (Baptist Medical, 2000).
"When you participate in
a Code Blue for the first time, everything you ever learned to prepare you for
that moment comes back to you in a
flash" (Dumbuya, A., personal communication, April 13, 2001).
·
Be familiar with your
hospital's code policy
·
Know whether your patient is
a DNR, Full Code, DNI, etc.
·
Be responsible for
documentation during a code (Turjanica, 1999).
o The timing of events: beginning and end of a code, when
a medication was given, time of death,
or time of transfer
o The treatments given: insertion of IV lines, ET tubes, or
NG tubes; administration of O2, defibrillation,
and
medications; monitoring of heart rate and rhythm, blood pressure, and lab data
o Obtain appropriate signatures on the code sheet at the
conclusion of the code
·
Be responsible for retrieving
needed supplies and medications from the crash cart
·
Perform chest compressions
·
Ventilate patient with
bag-valve-mask
·
Defibrillate as directed by
the Code Team Leader
·
Establish IV lines as ordered
·
Administer medications as
ordered
·
Call other departments and
staff as needed
·
Clear the room of
family/visitors; call the family if they are not present (Baptist Medical,
2000).
o obtain a member of the clergy if necessary
o answer any questions the family might have or obtain the appropriate
personnel as needed
·
Reassure other patients who
witnessed the code
Duties of Other Personnel
·
Physician - the first
physician to respond to the code will direct the code until the attending
physician
arrives
(Baptist Medical, 2000).
·
Anesthesia - if not detained
in the OR, will establish a patent airway through intubation
·
Respiratory Therapy - will
assist the Code Team in maintaining adequate ventilation; takes direction from
the
physician or other Code Team Leader
·
Pharmacist - will prepare
medications requested by the Code Team Leader; nurse or physician will
administer
the
medications
·
Administrative Nursing
Supervisor - will manage the code until the physician arrives; delegates and
assists in
activities;
assists with paperwork in the event of death of the patient; and ensures that
protocol is being followed
·
Other Personnel - the unit
secretary will maintain open phone lines; all other personnel will assist in
keeping
a calm
environment (Baptist Medical, 2000).
·
The nurse will take
directions from the physician leading the Code Team concerning orders for
medications,
defibrillation,
fluids, oxygen, etc.
·
A nurse should retrieve the
chart and communicate all necessary information to the doctor.
·
The nurse should also obtain
assistance from the physician in answering the family's questions.
Legal Considerations
·
Endotracheal Intubation
o
An RN may perform
endotracheal intubation as ordered by the physician after completing
a
required course (Alabama Board of Nursing, 2000).
·
Pronouncement of Death
o
A physician is required to
pronounce a patient dead; a nurse must report the absence of a pulse,
absence
of blood pressure, absence of a heartbeat, and dilated, unresponsive pupils
(ABN, 2000).
·
Scope of Practice
o
In addition to being able to
establish IV lines and administer medications, an RN may perform
defibrillation
and intubation during a code situation (ABN, 2000).
Alabama Board of Nursing. (2001). ABN position statement
download area. Retrieved April 15, 2001 from the World Wide Web: http://www.abn.state.al.us/pdf/ps/main-ps.asp
"Code blue." (2000). Baptist medical center east
policy and procedure. Montgomery.
Turjanica, M. A. (1999). Anatomy of a code: How do you feel
at the start of a code blue? Nursing
Management, 30 (11),
44-49.
Stephanie
Melton
NSG
4414
Troy
State University
April,
2001
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