COVID Code Blue

[Tait, MSN, RN]

Forgive me if this has been discussed. I did a quick forum search and didn't see anything.

I am curious how your facilities are handling COVID-19 codes. We are following the AHA guidelines from April ( https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.120.047463 ) but we have had situations where a patient isn't COVID + , has coded, and then be found positive. This was all despite previous negative testing.

Due to situations like this we have moved to managing ALL codes as COVID+ to prevent exposures. We are also draping our patients, which is causing the system to look at oxygen pooling fire hazard risk.

I am curious to hear how other facilities are managing codes in general.

Thank you ?

[Rose_Queen, BSN, MSN, RN]

We are also treating all codes as COVID/PUI.

[adventure_rn, MSN, NP]

I have nothing helpful to add besides the fact that it sounds like a total cluster. Pretty much every code that I've had in iso (often for relatively benign stuff like MRSA/rhino) has resulted in a ton of people flooding the room without adequate PPE. It seems like the whole production of donning/doffing full-blown COVID PPE (and the associated bottleneck at the door) would cause a huge delay in care.

Don't get me wrong, it absolutely makes sense to treat all codes as PUIs for the protection of staff. It just sounds like an unfortunate mess.

9 hours ago, Tait said:

We are also draping our patients, which is causing the system to look at oxygen pooling fire hazard risk.

Seems lie exactly what we need at a time like this...risk for fires and gas explosions..... ?

Godspeed.

[Tait, MSN, RN]

25 minutes ago, adventure_rn said:

I have nothing helpful to add besides the fact that it sounds like a total cluster. Pretty much every code that I've had in iso (often for relatively benign stuff like MRSA/rhino) has resulted in a ton of people flooding the room without adequate PPE. It seems like the whole production of donning/doffing full-blown COVID PPE (and the associated bottleneck at the door) would cause a huge delay in care.

Don't get me wrong, it absolutely makes sense to treat all codes as PUIs for the protection of staff. It just sounds like an unfortunate mess.

Seems lie exactly what we need at a time like this...risk for fires and gas explosions..... ?

Godspeed.

Today I was able to attend the code and it definitely was a cluster at the door, but honestly it looked better than our regular codes. We average 10-15 people in the room I swear. The last code put 13+ people at exposed. For this one I don't think we went over 8 in the room, which was 3 above our current protocol. Thankfully we don't have a lot of codes over all, but we are going to look at this one for learning. Ethics is also involved in how the system manages codes because truly we aren't doing everything as fast as we could with this process. As I told the nurse outside the door "Welcome to the spot between the rock and the hard place."

[Tait, MSN, RN]

Bumping this for more input.

[ICU_JOSIE, MSN, RN]

We have had a few cases of COVID+ patients who coded and the facility has by far been well-organized in its efforts. We limited our responders to 5 in the room (2MDs, primary RN, ICU/Code RN and RT). Each unit is equipped with a Level 2 PPE Packet for the 5 personnel initially responding to the code. The door is closed but one RN in full PPE gear is on standby to handout supplies and communicate other needs. Another team outside is listening in to the event inside the room via speaker phone. We communicate by identifying each other as "inside" or "outside" as to not create any confusion (e.g. "This is inside, please have a dose of Epinephrine ready"). One or two personnel may be added if the event takes longer to help with CPR. Once ROSC is achieved, our Transport Team takes over to send the patient to the ICU following SOP.

And also, we did MOCK CODES twice a week for about a month that was led by one of our Intensivists.