Calling Code Blue in ED - page 2

by becca001 | 12,995 Views | 36 Comments

As part of the Code Blue Team, I am participating in a committee to revamp our Code Blue policies. We are a 100 bed hospital with no tramua level designation. ED is 25 bed unit and sees between 100-190 pts in a 24 hour time... Read More


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    P.S. ... OP, is someone in anesthesia bored, that they brought up this idea? [/QUOTE]

    No. The two biggest proponents of this idea are managerial and educators. I'm not certain what their agenda is but it's become a fairly fierce debate. Currently, Director of the ED is saying no way. I just needed some input from others in the ED. Thanks everyone
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    Quote from becca001
    P.S. ... OP, is someone in anesthesia bored, that they brought up this idea?
    No. The two biggest proponents of this idea are managerial and educators. I'm not certain what their agenda is but it's become a fairly fierce debate. Currently, Director of the ED is saying no way. I just needed some input from others in the ED. Thanks everyone[/QUOTE]

    Becca, I think the thing is to remind your Managers and Educators that the purpose of a Code team is to respond to go to places where people do not have the skills to run a code. Not to interject into an area that is already capable of running a code. Do they have any idea how many codes or near codes occur daily in your ED?

    I can promise the ED staff will die laughing when a Code Team arrives to "rescue them"...
    I think you will also see poorer outcomes, frankly speaking. I have not seen a code team respond with the cohesiveness of an ED team that works together day in and day out...
    TheSquire, canoehead, ~*Stargazer*~, and 1 other like this.
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    I think it's a great idea for someone else to respond to emergencies in the ED. Then maybe as an ED nurse, I can go to lunch!:icon_roll

    Seriously though, I agree with what others have said. Why should someone come into "my house" to run the show when I am fully educated and capable and know where supplies are because I put them there? It seems like a recipe for conflict and poor outcomes to me.

    I would never want to respond to an emergency in the operating room, the delivery room or NICU, so why would they respond to an emergency in the EMERGENCY DEPARTMENT????
    canoehead, casi, Altra, and 2 others like this.
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    I know its such a naughty thought but all I can think is...you guys gonna take this patient right to an ICU bed the minute the code team intubates them right? You're not gonna need any ER resources right and you sure as heck wouldn't dream of leaving them occupying our bed and time now would you? ;-)

    its too much...really. lmao!
    ~*Stargazer*~ likes this.
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    I know this might not be relevant given the difference in size of the facilities but I will tell you how our CODE BLUE response works anyway. If there is a cardiac arrest in the hospital (700 bed facility) as in, anywhere BUT in the emergency department or ICU/NICU, emergency department nurse x 1 who must have ALS (two if we can spare the staff) and 1 senior ICU doctor respond. The phone call comes through to ED only (ICU doc gets paged). The nurse who answers the phone takes the details, it's categorised as either a medical emergency, or a cardiac arrest, I know it sounds silly but if no pulse it is us, otherwise it's not. In an arrest, nurse from ED runs with trolley to the respective ward, ICU doc meets them there. The idea of the ICU doc + ED nurse is that obviously, after an arrest ICU is next stop (or heaven) so it is ultimately going to be their patient, they can also decide to withdraw treatment. ED nurse is to run the code and assist with intubation, the idea of this is that we are the most experienced nurses aside from ICU to do it, ward nurses are always awesome and assist. ICU and ED deal with their own arrests, no team. If the call is a medical emergency, ICU nurse responds only. All the wards have what we call MERT (medical emergency response team) call criteria on all the patients observation charts, any vital sign that falls outside certain criteria is deemed a medical emergency and a senior medical registrar and ICU nurse will attend. Institution of this criteria has dramatically reduced the number of cardiac arrests that we attend. Our emergency doctors do not attend either unless there are exceptional circumstances (only once that I can recall, the ICU reg couldn't get the tube down and asked for help). This system seems to work well for us. If a code team (from elsewhere in the hospital) rocked into our ED for a cardiac arrest I would probably die laughing (so would ICU) but politics and non-clinicians tend to run these kind of shows unfortunately.
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    Thanks again for all the responses. I greatly appreciate any and all responses. You guys are the greatest.
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    Our code teams work similarly to the post above. Granted, we are a Level 1 Trauma center, and a academic medical center, but our ED fully handles all pre-hospital arrests themselves. Our ICU's handle their own codes (with the occassional exception of the Neuro ICU).

    If a Code Blue is called overhead, our ICU's rotate being code responders, and the Charge Nurses respond, along with the ICU and ED docs/pharmacists. Our hospital also has Critical Care Floats, who respond to codes(they do respond to the ED codes, but can be told to leave if adequate staff is available), help with ICU transports for scans, etc.
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    In my ED we don't call Code Blues when we have a pt arrest or a CPR in progress come in. ED staff handles all codes in our department. If there is a Code Blue called anywhere else in the hospital, one of our docs responds with one of our EMT's and the rapid response team also responds - but none of those are ED nurses. The ED charge nurse does respond with the EDP if a code blue is called in a off-unit area (e.g., lobby or CT scan). The RRT also responds in that situation as well.
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    I thought of this thread the a few days ago. I'm glad that my hospital calls all Codes regardless of where they occur. I was at the other end of our ED when a Code Blue was called in the ER. A patient suddenly coded in a room on the far end of where I was. I and other nurses would not have known this was going on. I was able to respond quickly to help out.
    Just another situational possibility in this scenerio.
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    Quote from Medic2RN
    I thought of this thread the a few days ago. I'm glad that my hospital calls all Codes regardless of where they occur. I was at the other end of our ED when a Code Blue was called in the ER. A patient suddenly coded in a room on the far end of where I was. I and other nurses would not have known this was going on. I was able to respond quickly to help out.
    Just another situational possibility in this scenerio.
    I'm not sure if this would help your department but if there is an emergency in any bay, or room, anywhere in our department, including imaging/ultrasound/short stay/CT, we have a big red button with emergency written on it that is wired into a (very) loud bell system. If that red button is pushed, the location will show on strategically placed signs around the department so everyone can see. This way, even if you have a pt. at the far end of short stay, if you press this button you will have a million helpers with a trolley in less than 30 seconds. Not sure of the expense but when woman gives birth in the waiting room toilets, I am glad that button is there!


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