Code Blue Announcement

RNsRWe, ASN, RN · Jul 3, 2012

The room number is not necessary, just the unit... any responders will feel the chaos.

I'd have to disagree, based on the differences in hospital design. My last hospital had floors designed on an 'oval' so that if you KNEW the room number, you'd know you were heading down the correct side of the unit to get to the patient's room....and if you were just trying to "feel the chaos" you could be on the wrong side, working your way back to catch the "feel"....and wasting time in the process.

As for the paging system, it's BS. It assumes too much: pagers must be on, accessible, infallible. Anyone who has ever attempted to reach someone quickly and found the pager was none of those things will agree that overhead paging is the ONLY way to go when life/death seconds are at stake.

Who wants to hear the post-mortem excuses of "my pager didn't go off", "the battery must have been dead", "I didn't know I didn't have my pager until I got the phone call saying the guy was dead".....??

Editorial Team / Admin · Jul 3, 2012

Batteries die, pagers malfunction. Overhead page with unit, pagers get unit and room number. At least this way, both ends are decently covered. As for the person with the oval unit, we have one of those as well. The two halves are designated as left and right, so that when the overhead page goes off, it includes left vs right. Perhaps that's a plan your facility could adopt if they refuse to announce room numbers?

RNsRWe, ASN, RN · Jul 3, 2012

Batteries die, pagers malfunction. Overhead page with unit, pagers get unit and room number. At least this way, both ends are decently covered. As for the person with the oval unit, we have one of those as well. The two halves are designated as left and right, so that when the overhead page goes off, it includes left vs right. Perhaps that's a plan your facility could adopt if they refuse to announce room numbers?

Mine was the oval facility, and it utilized only overhead pages with the room number. If you knew the place well, or worked in the facility (and therefore were responding), you'd know which side to go to based on the room number alone. You didn't even need the unit announced (based on the room number, we knew the location), but of course they did that, too.

I can see the L/R thing if there was even an ounce of room for confusion....why delay help?

prinsessa · Jul 3, 2012

At our hospital we have the overhead page with the unit only. Plus certain people (code team, supervisor, pharmacist,etc) get a page telling them which room the code is in.

KelRN215, BSN, RN · Jul 3, 2012

When I worked in the hospital, code blue was paged overhead but ICU STAT, Anesthesia STAT, Respiratory STAT all just went to pagers. Care to guess how many times an ICU STAT would turn into a Code Blue before the ICU team arrived? ICU STAT was pretty much our Rapid Response Team at this hospital... I remember one specific patient who when we called the ICU was in status epilepticus but maintaining her airway. We wanted the ICU there in case she went into respiratory arrest. Well, that happened several minutes before the ICU arrived and we ended up calling a Code Blue and intubating her as soon as the code team arrived. The ICU was offended because they were "on their way".

Scarlette Wings · Jul 3, 2012

paging may be part of the change that happens as technology advances. at one time no one had cell phones or pagers. (at one time the idea of skype could only exist as a sci-fyi thriller for the future) things are different now and with these advancements come trial and error. there is also the "keep the customer happy" concept and patient satisfaction scoring.

announcing a "code blue" would certainly interrupt the "peaceful healing atmosphere" of the hospital and could cause “undue stress” on one of the many visitors, family members, or patients. (please note the last statement is meant sarcastically).

each facility will have to find what works best for them. a hospital’s size or location would also influence how a code may be announced.

of course, i wonder how "polite" and worried about privacy administration and risk managers would be if it were a fire and someone wanted to "page" a code red and not alarm anyone about a room number?!

Altra, BSN, RN · Jul 4, 2012

I guess I'm going against the grain here, but overhead paging is viewed as old-school in my region. Codes have been called via pager in each of the three hospitals where I have worked. It works just fine - there is a "test page" that goes out once or twice daily to check pagers & the system itself. Zero issues with lack of response due to pager failure or failure to respond to the pager.

Delay because you're in an isolation room when the pager goes off?? Seriously?? If you're carrying that pager, you know what it's for. If you hear it, you're on your feet and out the door.

iluvivt, BSN, RN · Jul 4, 2012

We overhead page. Really!...Does the patient and family want someone to get in there and help save their lives or do they they want to relieve some family stress. I don't think the patient dying in 242 A really cares how HELP gets there..they just need them there STAT. IF..their is any kind of delay in getting health care workers to a CODE with the new system..the patient and Family will be the first to raise H###. The nurses at the place of the code can easily control the traffic and protect the patient. Plus our pagers do go down once in awhile..not often but it does happen.

BluegrassRN · Jul 4, 2012

I can see how, in larger facilities, overhead pages would be disruptive. In our smaller, 120 bed facility, we *need* the overhead page. If I hear a code blue called overhead, I know that I can't call the ED, ICU, or nursing supervisor to assist with a particularly hard stick...the extra staff are all in the code. I'm not going to call the ICU charge nurse to ask a non-urgent question, and I'm not going to call the nursing supervisor to ask him to go down to central supply and get me SCDs for my new admit.

My unit is old, designed as a long hall, with rooms on each side of the hallway, and the nurses station at the very end. Frankly, I've heard many a code blue called on our unit that, if we had a pager only system, I wouldn't have known about for several minutes. Now that I'm always in charge, I'm often the one who calls the operator or hits the code button, because as we all know, many times someone is circling the drain prior to actually coding and I'm usually in there assessing the situation already. But I appreciate that all my staff immediately knows what's going on, and can mobilize accordingly, covering pts, bringing the crash cart, moving things out of the way, bringing in a COW. It's very helpful.

airborneinf82, BSN · Jul 4, 2012

HIPAA violation and family anxiety? Like families don't know the room number of their own family members? Room numbers overhead without a name are PHI? What a load of hogwash...
. . .
The "let's be quiet about this" mentality is not a patient safety concern. It sounds like its a patient satisfaction concern...don't want anyone to know that there are REALLY SICK PEOPLE in this hospital!

Thank you. My point exactly.

Do you know for sure, what the change is driven by?

From what they said in the staff meeting was families expressing anxiety with thinking it might be their family member (I guess if they didn't hear the room number?) and a HIPPA thing.

It works just fine - there is a "test page" that goes out once or twice daily to check pagers & the system itself. Zero issues with lack of response due to pager failure or failure to respond to the pager.

Yeah the plan is now a twice daily pager test. But my concern is this. My unit is split in to a west side and east side (each with 21 or 24 beds). Now, lets say there is a code on the east side, and very experienced RN is on the west side. Overhead, they hear it, can rush to the room, MUCH FASTER than someone responding to a pager and from a different floor. Now with this experienced person in the room if there is chaos or things not happening as quickly as they should, they can take change and get the pads on and get the rhythm analysis going to possibly shock.

Now, remove the overhead paging. Experienced RN on west side has NO CLUE there is a code and the experienced person the patient and other RNs need is trying to get up there asap from another floor.

I remember reading a study about the outcome differences between shocking someone in VT/VF within 2 minutes being DRASTICALLY improved over even waiting 5 minutes. I just think if someone with the experience needed in this situation is now coming by pager from another floor, then hitting the 2 minute window is next to impossible.

About 1/2 down they have a table with similar numbers to the article I found... (still looking for it right now.. ok well can't find it now, I'll try again later). Here's this one though:

The Problem of Sudden Cardiac Arrest

Pediatric Critical Care Columnist · Jul 4, 2012

Our hospital doesn't have Code Blue buttons; all Code, MET and RRT calls go through the switchboard which pages overhead with the unit number. The Code Team carries pagers and we have a 0900 hours test page daily. MET calls also go overhead, but peds rapid response team calls do not... for those "anxiety and privacy" reasons. Problems with this system? Our pagers are ancient. They don't always work despite fresh batteries. So they got us some Companion phones. BUT... they don't work anywhere but on the 3rd floor and the peds inpatient units are on the 4th and 5th floors. The cafeteria, the cath lab, the ORs, the radiology department and all those other places the Code nurse might go in the course of the shift aren't on the 3rd floor either. Peds RRT calls go to the Code Team pagers, but the Code Team doesn't respond to them, the transport nurse does. If the RRT call then devolves into a code, the Code Team responds and the transport nurse returns to PICU... often passing the Code Team in the hall. The Code Team nurses are responsible for covering breaks in the PICU - usually in an isolation room. Hospital policy states isolated peds patients must have a nurse in the room while in PICU. So if the person assigned to the room doesn't hear the code paged and doesn't return to the room, time is lost while someone else comes to cover. It's a bit of a challenge sometimes.

DroogieRN · Jul 4, 2012

At my old hospital, a code blue was called overhead with the room number "scrambled" in such away that only staff (supposedly) knew what it was. At my new facility, codes are called with unit only, and staff are directed upon arrival. It seems that both ways require the same response time, in my experience.