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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. Follow these best tips to be the most confident code team member.
*(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!
Let’s get you equipped for feeling confident in a code setting……I promise you can do this
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
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
Here’s an article I wrote about the BEST NURSING GEAR. This is the nursing essentials for any bedside nurse:
Top Nursing Gear | What to Buy, The Essentials for any Bedside Nurse
Consider This when running to a Code
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:
You should 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.
Learn it, and remember
Learn exactly HOW to call a code blue 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 the code blue 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
What needs to be done in the first 3 minutes of a code blue emergency
-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.
-Make sure to 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.
-Give 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.
-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.
Don’t forget! All of these things can happen simultaneously during a code blue
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!
Assign each Nurse a Job
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.
- Take over compressions
- Do meds, check the IV access
- Set up suction and get the O2 connected or put together the ambubag
- Put him/her on the lifepak monitor. Place the defib pads if indictated
- Get a set of vitals. BP/RR/O2sat/HR/Temp and blood sugar
- Get a computer and open the patients chart
- Go be with the family outside the room
- Be our supply runner when we need something
At the end of the of the Shift
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, defibrillate, 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.
Get the Complete Guide to Bedside Nursing Here
Check out my course: HOW TO GIVE THE BEST REPORT.
The 8 Modules in this course teach you to:
– Initiate Report
– Courteous Tips the Next Shift Won’t Tell You
– Give Perfect Concise Report
– How to Call & Talk to Doctors
– How to Give Report to other Facilities
– How to Give Report when Going on Break
– How to Give Report to Other Floors
As nurses we all have BLS, but not everybody has ACLS, this article succinctly explains roles when a patient is “circling the drain”.
That is true. Some of this can be applied to BLS but as a cardiac nurse we use our ACLS nearly daily. I think this is where most nurses “freak out” and loose confidence. But they have the knowledge and know what to do – it’s the intimidation that creates hesitation. 🙂 I want to help eliminate the fear and help you save some lives.
Everything is very open with a precise explanation of the
challenges. It was really informative. Your site is very helpful.
Thanks for sharing!
Hey thanks for stopping by. My only wish for this little website is to be a helpful resource to all who visit. Whether it’s nursing related, travel tips, Disney advice or mom life encouragement. I have a need to help at the bedside and at “keyboard-side” lol. Anything you need – just comment here!
Sara | mshealthesteem.com
Thank goodness for nurses! I am so grateful for everything you guys do every day ♡. And I know this post will be an amazing resource for nurses. So happy you shared it ?
No problem Sara, anything helpful – I’ve got it here.
Peculiar article, just what I needed.
I blog frequently and I truly thank you for your content.
Your article has really peaked my interest.
I’m going to take a note of your blog and keep checking for
new information about once a week. I subscribed to your RSS feed as well.
I didn’t read suuuper thoroughly as I’m multitasking currently, but a couple of things I think I didn’t notice but are very useful to grab in any code blue are a step stool (to help with compressions on the bed) and also the back board if the bed doesn’t convert to CPR mode. Without the rigid board under the person chest compressions wouldn’t be very effective. Really there is nothing better in boosting confidence than practice so really good advice to run toward the code room not away 🙂
I visit every day some web sites and websites to read articles, however this weblog provides
quality based content.
Nancy Cassella, RN CCRN-K
This is a fabulous resource! My hope is that schools have their educators read this & recommend it to students!! New nurses should be following you as well! You do an awesome job of describing how life as a nurse in a hospital feels! My only comment is that you add defibrillation as a goal of treatment that’s under our BLS skill set. Most units should have a device available for anyone to deploy when someone goes ‘down’. The gaol of ‘drop to shock’ as set by the AHA (through the ILCOR process) is less than 2 minutes. That means someone should notice the defibrillator or AED hasn’t arrived yet. It should be on everyone’s radar to get it into the room, apply the pads in a heart sandwich as we all learned in our CPR class (even in Family & Friends!) and let the device tell us whether it’s a shockable rhythm. This metric is one measured for all hospitals in Get With The Guidelines-Resuscitation by the AHA and it’s the frontline staff who can make this (or not). Please keep up what you are doing here! It’s wonderful! Thank you!
perfect! That’s my goal!
Great article from a patient – 72yo female – who noticed my heart “pounding like crszy” one day.from my hospital bed. I pressed the big red button, as previously instructed. My heart rate, which was bring monitored there, suddenly, began going from 94 to 240. I felt like I was fading in and out, but remained conscious. It seemed only seconds before the room was filled with nurses, doctors and othders, and I remember that as they entered the room, each one assumed a duty. One went to the computer. Two brought the crash cart. They began hooking me up to a monitor on top of that. They placed the paddles on my chest. Doctors came in, too, asking questions, giving orders, and in all of the non-confusion, I noticed it was like a well I orchestrated symphony! Everyone did what they were supposed to do, and there was Amy. Her job, because I remained conscious and asked all kinds of questions, was to stand near me and hold my hand. She was the reason I didn’t panic. I was terrified someplace inside, but her concern, and her nursing instincts told her that was just exactly what I needed at the time, and it kept the “terror monster” inside -so that it would not create another problem for this excellent medical crew. The meds worked, and eventually my heart settled into a more acceptable rate. I couldn’t thank those blessed individuals enough for what they did. The reason for the episode was the reason I was admitted – I hadn’t been able to keep anything down for four days, AND that included any meds, including my “heart rate” one. The staff on the 3d floor of a very good hospital in Elizabeth City, NC, saved my life by doing exactly what you speak of in this article. They did their jobs (I’m sure they would say), but what I saw that morning was angels in my room. God bless all nurses, doctors and healthcare workers. I just thought you would appreciate the patient view relating to your article. BTW, I have 4yrs of patient care rxperience…during my college years.
Meg For It
Oh wow this is beautiful, Judie! ❤️ Such competent and compassionate medical staff. Thanks for sharing your experience!