INTERDISCIPLINARY CLINICAL MANUAL Policy and Procedure

Transcription

1 INTERDISCIPLINARY CLINICAL MANUAL Policy and Procedure TITLE: Code Blue - NUMBER: CH (c) Hants Community Hospital Effective Date: December 2013 Page 1 of 7 Applies To: Holders of Interdisciplinary Clinical Manual - Hants Community Hospital Refer to CC District Code Blue which provides general information on Code Blue emergency responses within Capital Health. POLICY 1. A code blue is called to provide a consistent, optimal resuscitation response if a patient is determined to be in cardiac arrest, respiratory arrest or in imminent life threatening medical emergency. 2. Capital Health will provide basic life support (BLS) to all patients unless an order has been written not to resuscitate or a personal directive exists and the patient s wish is not to be resuscitated. 3. The Code Blue Team is available on a 24-hour basis and is to be activated for: 3.1. any emergency (cardiac or respiratory) requiring resuscitation all Code Pinks (Pediatric Resuscitation) 4. Areas either have a Code Blue Team response or staff designated to provide emergency care until the arrival of Emergency Health Services (EHS). 5. Visitors/family members/staff that have a medical emergency are admitted through an emergency department. 6. Pediatric resuscitation: the Broselow Tape (a pathway for pediatric resuscitation and kept in the pediatric resuscitation kits) is to be used to guide decision-making during a pediatric resuscitation Pediatric defibrillation is the responsibility of the physician Once stabilized the pediatric patient is transferred to the IWK via ambulance.

2 Code Blue Hants Page 2 of 8 7. An Automated External Defibrillator (AED) can be initiated by any health professional who has received training in AED 8. The physician (i.e.: Code Blue Team Leader, the attending or covering staff physician or resident) determines when the resuscitation efforts are to be terminated 9. Physician leading the code is responsible to complete the Registration of Death and/or autopsy requisition forms and talk to the next of kin. 10. Members from various departments are to be assigned to the Code Blue Team on a shift basis. (Refer to Appendix A for Composition of Code Blue Team) 11. All members are required to: maintain BCLS certification. Note: Certification is to be renewed every 2 years maintain ACLS certification or advanced skill training as required by their roles on the Code Team. DEFINITIONS Advanced Cardiac Life Support (ACLS): Automated External Defibrillator (AED): Basic Life Support (commonly called CPR): Code Blue: Code Blue Team: A set of clinical interventions for the urgent treatment of cardiac arrest and other life threatening medical emergencies, as well as the knowledge and skills to deploy these interventions. A portable electronic device that is connected to an individual with electrode pads to automatically diagnose potentially life threatening cardiac arrhythmias and initiate defibrillation if appropriate. A procedure used when a patient s heart stops and breathing stops. It can include chest compressions, electrical shocks and rescue breathing. A term used to alert staff of a medical emergency. Consists of health care providers designated to respond to a code blue PROCEDURE 1. CODE BLUE 1.1. Activate the Code Blue by overhead page (dial 70) stating Code Blue, Unit and Room ; repeat this overhead page three (3) times to insure response.

3 Code Blue Hants Page 3 of 8 Exception: Emergency Department may elect to not activate the Code Blue Team. 2. CRASH CARTS 2.1. Location Situate crash carts at specific locations throughout Hants Community Hospital; ensure all crash carts are similar in physical structure and location of supplies on the carts House the Main Level Cart in the Emergency Department; take to all codes occurring on the main level House the Level 2 Cart on Unit 200; take to all codes occurring on Level II In the event a second Code Blue is called while the first code blue is still in progress, the nurse in the area where the cart is maintained brings the crash cart from the alternate level to the second code Post arrest, staff from the unit where the cart is maintained promptly check and restock the crash cart Supplies Adhere to the designed checklist, attached to each cart, when restocking the carts. Note: Changes in cart supplies or placement of supplies on cart is prohibited Check Crash Carts and Defibrillators daily using the appropriate checklist Sign the record after each check and forward to the Health Service Manager when the sheet is complete Upon use of cart, the staff nurse: checks the cart and restocks as required. Ensures the drug tray is replaced via Pharmacy (or after hours via ED Pyxis). Pharmacy upon return of tray, issues a replacement (either to cart or Pyxis) and completes the tracking record for both 3. PEDIATRIC RESUSCITATION 3.1. Keep the pediatric resuscitation equipment in the Emergency Department, on Unit 200 and Ambulatory Care Area. (Not on the mobile cart.) 4. DEFIBRILLATION 4.1. If appropriately trained in the use of the Automated External Defibrillator (AED) use the AED in any area of the hospital in the resuscitation of the collapsed patient prior to arrival of the Code Blue team A registered nurse may defibrillate during a Code Blue using the approved ACLS Algorithms.

4 Code Blue Hants Page 4 of 8 Note: Assessment of competency in Defibrillation: Using External Paddles/Multifunction Electrodes CC (PELC) policy is required prior to performing the skill. 5. EXTERNAL CARDIAC PACING 5.1. During a Code Blue, a registered nurse, who has been deemed competent, may initiate external cardiac pacing using the approved ACLS Algorithms. Refer to: Temporary Cardiac Pacing: Assisting with Initiating (PEL) CC Temporary Cardiac Pacing - Initiating Pacing/Adjusting Pulse Gen Settings (DMF) CC DOCUMENTATION 6.1. Use the Cardiopulmonary Resuscitation Record (CD0202MR) for the legal documentation of all resuscitation measures. (Refer to Cardiopulmonary Resuscitation Record CC ) 6.2. Complete all applicable areas on the Cardio-Pulmonary Resuscitation Record; team members review and sign the record as appropriate Document according to approved hospital guidelines. (Refer to CC Clinical Documentation in the Health Record.) 6.4. If less than one hour has elapsed between repeated Resuscitations, a new Resuscitation Record is not required. 7. ROLE OF THE TEAM MEMBERS 7.1. Emergency Department Physician On Duty (Code Leader) Assumes leadership position upon arrival and directs code blue management according to Advanced Cardiac Life Support protocols Intubates in absence of Respiratory Therapist Assists other team members if required (e.g. IV therapy, arterial blood gases) If resuscitation successful, arranges for transportation of the patient to appropriate area Contacts the family/next of Kin Note: In the OR, the Anesthesiologist acts as the Code Leader 7.2. Assigned Emergency Department Nurse Respond immediately to the code blue page; bring mobile crash cart if event occurs on 1 st floor.

5 Code Blue Hants Page 5 of Connect patient to the cardiac monitor if not already done, identify cardiac rhythm If the monitor is not in manual mode, switch from AED to manual Identify the Code Blue Team leader and accept orders/instructions from her/him Prepare for defibrillation/cardioversion/external pacing Defibrillate/cardiovert/external pace according to ACLS guidelines Starts IV, if not established Administer medications as ordered Document in consultation with the unit nurse using the Cardiopulmonary Resuscitation Record (CD0202MR) For Code Blue in the OR administer medications 7.3. Clinical Leader/Charge Nurse Unit 200 (Monitoring and Defibrillation) Bring the mobile Crash cart if event occurs on 2 nd floor Connect the AED/LifePak 20 to the patient Perform defibrillation if advised (AED mode) Assist with intubation as required For Code Blue in the OR monitors/defibrillates Respiratory Therapist (Airway/Ventilations) Intubate Ventilate For Code Blue in the OR Assist with ventilations 7.5. Staff Nurse for the area of the code (BLS Provider): Initiate and continue BLS Assist with ventilations in the absence of RT Assist with any equipment needs Coordinates activity and staff Primary Nurse Provide ongoing information related to the patient

6 Code Blue Hants Page 6 of Contacts the Family Physician Document: pre-arrest status times of occurrences, initial rhythm and changes with accompanying strips, drugs, procedures and responses, defibrillation and responses, outcome of resuscitation, Obtains required signatures OR Staff (For Code Blue in the OR) Perform BCLS Respond to equipment requests Record/Document as appropriate Security Secure an elevator if required Hold the elevator until the patient can be transported to the elevator Health Services Manager/Administrative Coordinator/Delegate Receive notification of a code blue but does not necessarily respond to the location Provide advice and support as required 8. APPROVED ACLS ALGORITHMS 8.1. Refer to the following approved ACLS algorithms (available on all Crash Carts): ACLS Cardiac Arrest Algorithms ACLS Cardiac Arrest Circular Algorithm REFERENCES ACLS Provider Manual 2010 American Heart Association Richard O Cummins (Editor) Cardiopulmonary Resuscitation Targeted Responder Heart and Stroke Foundation of Canada 2010 RELATED DOCUMENTS Policies CC CC Temporary Cardiac Pacing: Assisting with Initiating (PEL) Temporary Cardiac Pacing - Initiating Pacing/Adjusting Pulse Gen Settings (DMF)

7 Code Blue Hants Page 7 of 8 CC CC Cardiopulmonary Resuscitation Record Clinical Documentation in the Health Record Forms CD0202MR Cardiopulmonary Resuscitation Record Appendixes: Appendix A Composition of Code Blue Team Hants Community Hospital * * *

8 Code Blue Hants Page 8 of 8 Appendix A Composition of Code Blue Team Hants Community Hospital Code Blue Team (exception Operating Room) Emergency Department Physician (ERP) Emergency Department Nurse Clinical Leader Emerg and/ or Clinical Leader Acute Care Unit 200 Charge Nurse Primary Nurse on unit where code occurs Respiratory Therapist Code Blue Team - Operating Room Anesthesiologist (The ERP does not respond to codes in the OR) Clinical Leader Emerg and/or Clinical Leader OR Emergency Department Nurse Unit 200 Charge Nurse Respiratory Therapist OR Staff