*(updated Jan 2019)* There has been a BIG announcement from the American Heart Association about CPR changes coming in 2020. Please read RQI® 2020 Launch and tell me what you think this means for nurses!
Hi there! My name is Meg. I have a BSN in Nursing from Florida International University. I have been a nurse for the last 9 years. I have worked ER, Telemetry, Med-Surg and Cardiovascular Step-down. I love being a nurse and teaching future nurses how to be the best they can be. Check out my comprehensive download: A COMPLETE RN RESOURCE EBOOK. It’s a helpful guide with printouts to make your shift easier and more organized. I love helping fellow nurses – and since I can’t help ALL of you boost up a patient or cover your break – so I started this blog! (Side note: I also blog about motherhood, travel, and all things Disney – if you are interested.)
Let’s get you equipped for feeling confident in a code setting……
Many nurses and techs are afraid of a code blue / code rescue/ rapid response. Just the sound of the overhead speaker strikes fear in their little healthcare loving hearts. I don’t want you to feel afraid. I want you to feel CAPABLE and CONFIDENT in your skills.
If you’re interested, these are “Greys Anatomy” Scrubs in “Wine” color
No code blue will be perfect or textbook, but if we all do our best in our roles – the outcome of the patient will be better. That is why I wrote this post. I want you to use it as a reference guide. It is ESPECIALLY for those who feel intimidated by the phrase code blue or rapid response.
I strongly believe in empowering my fellow nurses. We are the frontline of defense. “In the 23 hours and 55 minutes that your doctor is NOT in your hospital room – it will be a nurse saving your life!” – unknown
One day, you will take care of my grandparents, my parents, my kids, my friends, and maybe MYSELF one day! I want you all to be the best nurses you can be and have a passion for this important super hero role you’ve taken on. You can’t just be loving and caring when things are going well….you also need to be ready for the patient to deteriorate. It’s time to call a rapid response or a code blue….
Call a Rapid Response / Code Rescue:
Call a Rapid Response / Code Rescue when the patients condition is worsening and you need help right away. This can be severe unexplained pain, a super high or low blood pressure or heart rate, a change in heart rhythm with symptoms, or syncope (fainting) while still breathing and has a pulse, etc.
Call a Code Blue:
Call a Code Blue when the patient is NOT breathing or has no pulse/heartbeat. Please don’t waste more than 10 seconds searching for a pulse.
First things first
First and foremost, learn exactly HOW to call a code in your hospital and have a list/badge/cheat sheet of all the codes. Ask your trainer/preceptor multiple times. Practice it in your head. Make it second nature so that when you need to call a code blue, you won’t need to hesitate to try to remember how. You got this!
- The most Common codes you will call are Code Blue: (no pulse not breathing)
- Code Rescue/Rapid Response: (Change in status, need immediate assistance),
- Code Green/Gray: Combative Person – need man power.
Learn what number to dial and commit it to memory. The most empowering thing is knowing how/where to get help. When you call the code line, speak clearly and say “Code ____ to Room ____ please”. They may ask you to repeat it for clarification and confirmation. Great, now it’s announced and help is coming!
What if it is not your assigned patient? What if you are in a separate area and you hear a code being called overhead, do you run and hide? No! You are an amazing and smart nurse. You are capable and you can help! Run TOWARDS the room. Don’t be intimidated.
With my tips and lists you can be the most confident code team member.
Get ready to impress the only person you need to impress….YOURSELF
Let’s go over what needs to be done in the first 3 minutes
ALL OF THESE THINGS CAN HAPPEN SIMULTANEOUSLY
-Initiate compessions if Code Blue. (Elbows locked, hard & fast guys!) Always double check the patients code status. (They might not want to come back, check if they have a DNR bracelet or order)
-Bring the code cart into the room
-Someone needs to take the role of recorder and start filling out the Code Blue form or Rapid Response Form.
-Put the patient on the lifepak monitor to see the heart rate and rhythm.
-Put the defib pads on if patientt is super bradycardic or in V-tach.
-Put the patient on Oxygen, Venti-mask, or Non-rebreather – as needed. The same person managing the airway/oxygen should also set up suction in the room and will be the respiratory/intubation helper. They will help assist to ambu-bag or suction.
-Get a set of vitals! Get a manual BP cuff if patient is severely hypo/hyper tensive.
-Get a temperature and a blood sugar for the record.
-One Nurse should check for IV access/Central line access. Flush the lines with saline to make sure they are patent and announce that they will give meds.
– One Nurse should have the WOW/computer & patient chart open ready to put in new orders. This nurse can also be ready to answer questions about the patients recent labs or scans.
– Call the attending MD, but hopefully an ER doc or ARNP or whoever your hospital designated will show up to help run the code.
-From then on everyone stays in their role and awaits orders from the MD/ARNP who is running the code.
FYI. Total side note… This is the Stethoscope I’ve used for the last 5 years. It’s super lightweight to wear around your neck for hours at a time. It has excellent sound quality (for those mysterious lung sounds). It also comes in lots different colors and won’t break your budget!
All of these things can happen simultaneously.
If each nurse comes in, grabs a role and waits for instructions – that is the ideal code team! There will be times where it feels chaotic and staff needs to be told to get in a role. This delegation can come from the charge nurse or the coding patients nurse. If a code is called on your patient and other nurses come running in – give each nurse a job! Take command and organize your code in the first 30 seconds.
- You take over compressions
- You do meds, check the IV access
- You set up suction and get the O2 connected or put together the ambubag
- You put him/her on the lifepak monitor. Place the defib pads if indictated
- You get a set of vitals. BP/RR/O2sat/HR/Temp and blood sugar
- You get a computer and open the patients chart
- You go be with the family outside the room
- You be our supply runner when we need something
A big piece of advice to everyone who shows up, stay in your role. Once you have a job – stick to it till the end. Remember to trust your training. You have done this before. Read and reread the steps above. Keep them in your pocket and refer to them during a code. Also, a great thing to note is that a lot of the preliminary things can be done by a Nurses Aide OR a Nurse. A Tech can get vitals, blood sugar, do compressions, and slide the code cart in. They are your 3rd arm in patient care, and we should be so thankful for techs! After a code, look around the room to see the equipment they used. See how the ambubag is put together. Look through the code cart drawers. It is important to get familiar with what is inside each drawer and how your hospital organizes code carts. But from all my travels and nursing experience – it’s pretty much the same everywhere. There are only a few important things inside a code cart. There are top drawers for meds, IV supplies, line kits, resp supplies. You can learn and memorize each drawer after exploring it only a few times. It’s also a good idea to learn the lifepak. Ask someone to teach you how to pace, defibrilate, and print a strip.
If you want any help, I have a great digital download called The Complete RN Resource eBook. It has tips, report sheet examples, how to give the best report, how to do a 5 min morning assessment, a daily flow of your shift print out, quick EKG interpretations, how to talk to doctors, and more! It’s literally everything you need for a good foundation as an RN.
P.S. Here is my post on “Tools for Successfully Managing Night Shift“. Night shift can be rough on the nurse and their family. Here are a few tips to make life a little bit easier.
You can do this.
I believe in you.