Calling Code Blue in ED

[becca001]

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 frame. The Code Blue team is different members throughout the hospital, all ACLS nurses and hospitalist/interns. Some on the committee are arguing that Code Blue should be called within the ED for all codes, including pre-hospital arrests, citing EBP's that standardized response increases outcome. Some(myself included) argue that responding to an arrest that began pre-hospital creates chaos to a team that is already established. My other part to the arguement is that I am leaving 4 critical care patients (I work weekend nights) to respond. What is the procedure at your hospital? What would you change if you could? Thanks in advance to all who read and answer.

[emtb2rn, BSN, RN, EMT-B]

I work at a 300 bed hospital, level 2 trauma center. The only place that codes aren't called overhead/hospital wide is in the NICU and Cath lab. Otherwise, they are announced, even in the ED. Our code team is 1 ICU nurse (first nurse), 1 cardiac nurse (IV nurse), 1 medical nurse (recorder), whoever the primary nurse is, hospitalist, sometimes resident, sometimes ED doc (if hospitalist is unavailable), and RT.

Are all these non-ER folks standing by in the ER waiting for codes or do they have to come from various other places in the hospital? What happens with the dead guy while the team is enroute? ER staff runs the code until the "pros" show up or y'all just wait?

Seems weird. Codes are what we do. Plus I like having a different role each time. Including running the code - "where's the doc?" "i dunno, continue cpr, when was the last epi?"

[Esme12, ASN, BSN, RN]

The ED starts the resuscitation when the team arrives they return to the other ED patients. Many times once the "Team" arrives they are dismissed. Depending on what is going on in the ED it allows the rest of the staff to keep running the ED. The responding "Team" have specific duties. The ED staff member is code leader. ICU #1 giving drugs, IV team to secure IV access and they leave. RT for intubation if necessary and then they monitor the ETT. NICU responds to Code Pinks (under 3 months) and surprise deliveries. Step down/PCU records. It actually works. The place I knew had the hospitalist respond to admit what he can to clear the Department or place lines....freeing the ED doc to do the ED.

[ecerrn]

The hospital I worked at made up a code team, basically to respond to nurse stats ad codes on the floor, so an er RN did not have to leave a already swamped assignment. If the er needs additional staff to work a code, they will call for experienced people for it, maybe the director needs to put on scrubs, mostly its for a specialist...but really don't need help working a basic code for goodness sakes.

[Christy1019, ASN, RN]

I work at a 300 bed hospital, level 2 trauma center. The only place that codes aren't called overhead/hospital wide is in the NICU and Cath lab. Otherwise, they are announced, even in the ED. Our code team is 1 ICU nurse (first nurse), 1 cardiac nurse (IV nurse), 1 medical nurse (recorder), whoever the primary nurse is, hospitalist, sometimes resident, sometimes ED doc (if hospitalist is unavailable), and RT.

Ok I apologize if I'm just reading to far into this but there's a few things I found a bit odd with this system... 1. I get the no codes called on nicu but why call em in any ICU, OR, or ER period? ER, ICU, & OR staff are specifically trained to handle these situations, not to mention if a pt codes in the OR, is the whole code team gonna rush into the sterile OR and potentially complicate whatever procedure that was in progress pre-code? Besides they already have a scribe and circulating nurse, anesthesia for airway and meds, and pt will obviously have iv access, so what's the point?

Also, in the described code team, it seems somewhat stereotypical or politically incorrect lol, to have the PRIMARY nurse be from ICU, the IV nurse be a cardiac RN (is that their specialty at your facility), and the medsurg nurse handles the "charting", as if they can't handle anything more complicated. And if they responded to my ED for a code (that would've never been called overhead anyways), we might laugh as they arrive to find that we have already controlled the situation all by our lowly selves lol.

[DC Collins, ASN]

Our ICU actually does not call codes overhead either anymore, because again, there is an intensivist 24/7 in the ICU and all the nurses there are fully trained in code procedures.

I kind of sound like a big bag of wind, but I think it's kind of an odd idea. the Emergency Dept is for Emergencies.

Hear, hear. In our hospitals, ICU will call a code because there isn't an intensivist there. So an ED doc does run down there. And ED nurse goes as well just in case the ICU is nuts and more RN hands than just the primary ICU nurse is needed, but the ED RN is almost always sent back to the ED. One of the ED techs because the ICU doesn't have techs and an extra pair of hands may be needed. But sometimes they are sent back too.

In other words, we go just in case they are short of hands, but they certainly know what they are doing and don't need us for any other reason.

DC :-)

[Rhi007]

I am a volunteer in the ED until I get into nursing school and the other day I ended up calling a code blue on a 55yr old male. Yes I have the training to call one due to my St. John training. While I started compressions it literally only took 2mins to get help. I all but have secured a job in the ED when I've finished my training :fist pump:

[Christy1019, ASN, RN]

I am a volunteer in the ED until I get into nursing school and the other day I ended up calling a code blue on a 55yr old male. Yes I have the training to call one due to my St. John training. While I started compressions it literally only took 2mins to get help. I all but have secured a job in the ED when I've finished my training :fist pump:

Way to go! Just for curiosity's sake, what was the situation?

BeLLaRN

[Rhi007]

Way to go! Just for curiosity's sake, what was the situation?

BeLLaRN

55yr old male arrived via ambulance with chest pain, initial exam showed slight elevation in ST waves pain. After half an hour when I walked past he was having a STEMI, cyanotic ( lol lucky I have had O2 training with St. John) I held his call button which triggers the emergency bell and yeah...

[nuangel1, BSN, RN]

we don't call codes in my ed either .we are all there .the only people we will stat page is the resp therapist because they are not in the ed .and the icu i worked in we did not call them either .we took care of our own codes.

[DC Collins, ASN]

I am a volunteer in the ED until I get into nursing school and the other day I ended up calling a code blue on a 55yr old male. Yes I have the training to call one due to my St. John training. While I started compressions it literally only took 2mins to get help. I all but have secured a job in the ED when I've finished my training :fist pump:

Love it!

DC :-)

[HyperSaurus, RN, BSN]

har...apparently I already posted to this thread. God-bless night shift.

[HyperSaurus, RN, BSN]

Christy1019-

No codes called in OR. I have no idea why codes are called in ICU, ED, ect. I do know at a recent code I responded to (as recorder), the ED nurse said she hadn't had a code in 7 months. I know our facility is the exception, not the rule. My dad works at another facility who refers to mine as 'that witchdoctor place.'

It seems to me that the code roles at our facility are somewhat..well, politically-incorrect, as you put it. I know sometimes the ED nurses run their codes, and other times it's an ICU nurse.

I'm from a medical floor--it's like pulling teeth to actually get into an ACLS class, and I have no idea why it's necessary to pull someone from just about every floor.