Rapid Response vs Code Blue?

[Marijane]

I work on a cardiology floor. In a code blue, the patient is unresponsive and does not have a pulse. In a rapid response, there is a change the patient's status, such as difficulty breathing, hypotension, oxygen sats less then 90%.

[Popwhizbangz, LPN]

Keep in mind - many such questions have answers that are completely site-specific. Where I work, neither term means anything: we have "Codes", and medical and paychiatric emergencies. Such terms refer to a very specific response elicited whenever each one is called, as determined by your institution. You need to learn the lingo where you work, and learn to use the appropriate term to get the help you need in any given situation. Forget the NCLEX, except in terms of learning how to make those clinical judgements.

[MunoRN, RN]

I think you'll find the definitions for a rapid response, and when a RR becomes a code, varies by facility.

In general, A RR is for a significant change in patient condition, and used to hopefully avoid a code. The policy at my facility still defines a Code as being for any unstable patient and/or when ACLS is indicated. Although in practice you pretty much have to be pulse less to get coded, mainly because if the code teams arrives and the patient is still conscious or breathing at all they will turn around and leave, even if the patient is in a sustained Ventricular rhythm and symptomatic.

As a result, we do non-pulse less ACLS algorithms (tachycardia, pulmonary edema, etc) as a RR and pulse less algorithms as a code.

What earns a RR also varies some by floor, ie: Medical and surgical floors call a RR for chest pain, the tele floor does not. The observation unit calls a RR for O2 sats.

[Flo., BSN, RN]

A code blue is an unresponsive pt with no pulse

A rapid response or at my hospital a code yellow is when there is a rapid decline in the pts condition and you need help fast.

My hospital does not punish the nurse / pt for calling a wrong code. If you call a code blue but it is really a yellow the team will still stay and stabilize the pt. In a debriefing a supervisor would just explain the difference But calling the wrong code is better than calling no code so our code team is taught to be really supportive to the floor nurse.

[Esme12, ASN, BSN, RN]

Honey, Don't get hung up on the words......It doesn't matter what you call it....but if you need help call for it!

If someone in the kitchen calls a code because someone passes out ......I would rather run and have nothing to do than not run and have a dead body!

There will always be someone in the crowd who knows it ALL and will roll their eyes and say...."I have NO idea why she called a code/RR......it's OBVIOUS there's nothing wrong. IGNORE THEM! if you need help call for it.......It's a whole lot easier to back down than say "I wish I would have....." Some people just can't help themselves and have to say SOMETHING about EVERYTHING!

Some facilities have specific criteria for calling a code or Rapid Response,find your facilities and get to know it....but never hesitate calling because you are trying to debate what to call......just call. Time will pass and your will get more experienced and before you know it it will be second nature!

[casi, ASN, RN]

Code blues are called when someone is pulseless or not breathing. We have code blue buttons in all of the rooms so if it looks like a code is immanent (ie pulse & bp rapidly dropping, unresponsive and foaming at the mouth...) The people that show up in the hospital I work at are pretty much the same.

What a rapid response gets called for really depends on the floor. Different levels of care are able to handle different situations.

[VICEDRN, BSN, RN]

Would like to add that rapid response can apply to sudden acute change to mental status...

In my facility, RR has a set of guidelines that are specific. For example, new onset of systolic bp less than 90 earns the patient an RR. Symptomatic hypoglycemia past a certain point (sorry can't remember what it is...work in ER) earns you an RR.

Passing out during PT? Also an RR.

Found unresponsive...Code.

[Mandychelle79, ASN, RN]

In the facility I work in the main difference is that for a RR 1/2 of the CAT ( our code blue is called cardiac action team) shows up. Im thinking its IV, nursing supervisor, Respiratory and an ICU nurse. It is used when a patient just has deviated a lot from their base line. Could be resp issues, low or very high blood pressure, fainting, basically just heading south quickly. We can call an RRT on someone who is a DNR.

[nerdtonurse?, BSN, RN]

Code Blue -- patient is dead

Rapid Response -- change in pt condition from respiratory distress/severe hypotension all the way up to "almost dead, just about to die." Don't call a Rapid Response if the patient's not breathing or doesn't have a pulse. We had a nurse call a RRT, because the patient had lost a pulse but was still "breathing" -- the patient was having agonal respirations, O2 sat was in the 40's and dropping, and asystole. Pt should have been a code. I got there, slammed the button, but it cost the patient 3 minutes they didn't have.

When in doubt, hit the big blue button. I'd rather run to a code that was a RRT than hurry to a RRT that should have been a code.

[mama_d, BSN, RN]

Rapid response is "Oh crap, they don't look good".

Code blue is "Oh *% get the crash cart".

At my facility the goal of a RR is to avoid a full blown code. Basically if there is a change in condition to the point that if there is not rapid intervention the pt will potentially die or suffer serious harm, we call a RR.

So it kinda depends on the nurse and the floor as to whether or not a RR gets called.

Like in the post above...some would go ahead and call a RR for the first scenario presented...some would slap on increased O2, call RT to come check the pt, assess for any changes in LS, and call MD for further orders (assuming that there was improvement in sats).

It's kinda fuzzy...depends on the pt, the experience level of the nurse, response to interventions, etc.

Bottom line though is it's always better to call a RR, or even a code, and not need all the extra help than to wish you would have hit that button a few minutes earlier.

[SNB1014, RN]

At my facility, when we call a rapid response, we do not get a physician hence someone to intubate. It is correct to call the rr because you look at this pt is who rapidly decompensating and you think "oh hell nawww, he won't be able to keep up breathing like this for long!!" but, he is still breathing and "technically" OK (re: not in resp arrest).

So, what often happens is at my place, a rr will be called, the team gets there and the patient looks like respiratory garbage. They call a code blue to get someone in there to intubate. The patient is not dead, but intubating is the best choice for them right now.

I have heard rr for opiate overdoses, pt is breathing (barely) but unresponsive. All they need it narcan, usually and closer observation. Additionally, I had a little old sick lady who was baseline mildly hypotensive at change of shift but by med pass she was 75/35. I paged 2 different doctors to get orders. 10-15mins later I still have no response. I'm thinking "ohhh man, she isn't dnr so this is gonna get messy!" I called a rr, they came in less than 2mins, started hanging fluid boluses and transferred her to ICU in less than 7 mins with the intensivist ready to take the lead. The Dr called back after the pt went to ICU. I explained that I had called (and ohhh you betcha I documented it in the computer!) but I was scared the pt was going downhill too quickly.

Also at my facility, when a pt is admitted, we explain rr to families. Families are allowed to call a rapid on their loved one. We would hope that the nurse sees something first, but you never know. We would hope they would also let the nurse know something is wrong first, cuz its pretty awkward to hear a rr/code paged to your room overhead and you have no clue.

Lastly, we are making a big push to ensure rr are called before a code. It is saying that the nurses are "vigilantly" monitoring the pt for a change of status. Also, as most people know, even the best run codes do not always end "satisfactorily" so it is usually a better outcome when we catch a decline (aka weird new rhythm) vs asystole.

Also, important to note, from what I have heard and seen a few times, it is unusual for a patient to immediately and suddenly go into asystole. There is usually a rhythm change, first a slight one and then a major one (v tach, v fibb) before a patient has no electrical activity in their heart.

[rita359]

If your patient is still responding but is deteriorating call a rapid response (thank God for them because back in the day you had no option except to call the doctor which was generally someone on call who had no clue about the patient). If the patient is unresponsive and you can't find a pulse call a code. ICU head nurse says it is easier to downgrade from a code to a rapid response than it is to ungrade to a code. If you think you need help get it one way or the other.