Word: C&W Adult Code Blue Team: Roles And Responsibilities



Site Applicability Patient or Visitor Adult Code Blue response responsible for covering all areas of the Children’s and Women’s Hospital: Teck Acute Care Centre (Teck ACC), BC Women’s & Children’s building, Shaughnessy building (all floors), Healthy Minds building and Ambulatory Care building.Practice Level All Health Care Providers on Code Blue team Initiation of Basic Life Support (BLS) including Cardio Pulmonary Resuscitation (CPR) is a basic skill for those competent in the provision of BLS Initiation of Advanced Cardiac Life Support (ACLS). Components of emergency cardiac care that entail more advanced skills, e.g., interpreting cardiac rhythm, use of manual defibrillator, administration of emergency cardiac drugsAll Adult Code Blue Team members must have current BLS and ACLS certification and maintain knowledge of ACLS algorithms, ACLS drug monographs, and required emergency equipment. Policy StatementsHealth care providers with CPR in their job description must maintain competency with current Heart and Stroke Foundation of Canada CPR and EDD standards and guidelines. Health Care providers on the BCW Adult Code Blue team must have current ACLS certification. All Adult Code Blue Team members obtain and carry the Code Blue Pager at all times unless suitable alternate coverage has been arranged. All Adult Code Blue Team members ensure they are logged in and added to “BC Women’s Adult Code Blue Team” group on Vocera at all times unless suitable alternate coverage has been arranged.All Adult Code Blue Team members know how to navigate and way find campus/building locations including Crash Cart locations (see policy BC Children’s and BC Women’s Hospital Clinical Codes) For additional Code Blue Team support, at the discretion of the team lead, consider Urgent Call via Vocera to “PICU fellow”. *2 Registered Nurses and *1 NICU Respiratory Therapist are assigned to BCW Adult Code Blue Team each shift. At the beginning of shift, these members need to login and add themselves to Adult Code Blue team on Vocera device by calling Vocera Genie and stating “Add me to BC Women’s Adult Code Blue Team”.Clinical IndicationA code blue is initiated by any health care professional to provide a coordinated response, and summon additional resources, to any life-threatening situations such as cardiac arrest, respiratory arrest, choking, anaphylaxis, or seizures. The Adult Code Blue team assumes care of victim and determines need to transfer care to another facility as required. The PRIORITIES of ACLS responders, if the victim is in cardiac arrest, are:High quality chest compressions with minimal interruptions <10 sec with pulseless arrest.Early defibrillation, if indicated.Team functions are not rigidly defined. Teamwork is key. Team members must be flexible and may need to assume more than one role i.e. Defibrillator + CPR Coach roles or Event Manager + IV/IO Medication roles. All team members must be able to carry out any role required, including acting as team lead. If Victim >20 weeks pregnant and no Return of Spontaneous Circulation (ROSC) by 4 minutes prepare for in situ perimortem delivery and confirm Code Pink and Neonatal Resuscitation teams are called. Team MakeupRequired: Anesthesiologist LDR Respiratory Therapist (NICU) * ACLS RN #1 *ACLS RN #2 *Clinical Nurse Leader Other: Anesthesiologist OR EmergencyOB residents x2 (on call most of the time)Anesthesia Assistant (on shift most of the time)Anesthesia Resident Clinical Resource Nurse (Days only) Team Member RoleResponsibilityTeam Leader -usually BCW AnesthesiologistApply TEAM LEADER armband Anesthesia Resident or OB resident can assist Team LeaderThe Team Leader manages patients according to the ACLS algorithms upon arrival to the code.Confirm adequacy of ventilations and/or compressions & analyze rhythms during cardio pulmonary resuscitationEnsure defibrillator pads are in place and assess need for electrical interventionMake treatment decisions: determine drugs, dosages & fluid therapy Consider advanced airway with Airway Team #1 and RTSummarizes interventions regularly in conjunction with Recorder and ‘asks for suggestions’ from the teamConduct primary and secondary surveysTerminates resuscitation efforts as appropriate Determines need for BCEHS (9-1-1) for visitor, PTN for maternal/patient transfers outOB resident can assist Team Leader:Obtain and provide patient history, ensure ACLS algorithms are being followedAirway #1 -usually Anesthesiologist #2, Anesthesia Resident, AA, or RTApply AIRWAY armbandManage airway and ventilationConsider Intubation/advanced airway management with Team LeadMonitor End Tidal CO2Airway #2-usually AA or RT Apply AIRWAY armbandAirway management including assisting with intubationAssist airway stabilization of victim prior to transportObtains transport ventilator if requiredCompletes ventilator set up and manages ventilation settings as prescribedObtain ABG and run to NICU/PICU to analyze sample (including Hb, electrolytes, lactate, glucose, etc) (PICU: Frog T4 200 block, Fox T4 300 block)(NICU pods: Ladybug T2-200, Dragonfly T2-300, Bumblebee T3-300) IV/IO Medication #1ACLS RN #1 - (pager 4101040)Apply IV/MED armbandBring adult intubation drug kit, Red ACLS drug bag, glucometer and BP cuff bag from LDR or UCC in BACKPACK Intravenous or Intraosseous access as clinically indicated Prepare and administer drugs as directed by Medical Team LeaderDouble checks medications with IV/IO Medication #2 and administers Uses closed-loop communication to report completed interventions to Team Leader and RecorderIV/IO Medication #2 -ACLS provider, usually RN or AA(CNL could do Event manager and IV #2 role)Apply IV/MED armbandAssist with access, draw up medications Double checks medications with IV/IO Medication #1 as directed by Medical Team Leader Uses closed-loop communication to report completed interventions to Team Leader and RecorderDefibrillator-ACLS provider, usually RN or OB resident if patient NOT pregnant-could be dual role for CPR coach)Apply DEFIB/CRASH CART armbandCPR Coach -may be OB resident-could be dual role for DefibrillatorApply CPR COACH armbandDefibrillator role:Attaches defibrillator pads to patient if not already in situ and ensures rhythm registering on defibrillatorConsider switching from AED to manual defib mode at direction of Team LeaderOperates monitor/defibrillator per ACLS protocolsUses closed-loop communication to report completed interventions to Team Leader and RecorderCPR coach: Keeps track of 2 minutes and choreographs team activities around 2 minutes ensuring minimal time off chestMonitors CPR feedback from Zoll and ensures compressor is pushing hard enough, fast enough, and with sufficient recoil Rotates compressor every 2 mins or sooner if compressor fatigued and not meeting compression targets. Monitors ETCO2 to maintain >20 and alerts team if below, or if ROSC is achieved and ETCO2 increasesKeeps rhythm, pulse check and airway placement to <10 secondsRecorder -Ideally ACLS provider-BLS unit staff if not enough team attendeesApply RECORDER armbandPosition yourself in order to see and hear events of careMaintains an accurate written record of the timing of interventions including: medications, resuscitation interventions, and vital signs every one minute on the Resuscitation Record Prompts Team Leader of timed interventions per ACLS algorithmsCommunicate directly to Team LeaderPrompt 3 minute intervals for next dose of epinephrine and 2 minute intervals for rhythm checks (if CPR ongoing)Summary of interventions givenDocumentation for cardiac arrests must include: If the arrest was witnessed or unwitnessed If pulse was present or absent upon discovery If respirations were present or absent upon discovery Use appropriate site specific designated code blue record to document code blue activities The hard copy of the code blue record will be the source of truthThe members of the Code Blue team are required to verify the record and print and sign their names to the Resuscitation recordEvent Manager (CNL)Apply EVENT MANAGER armbandFill gaps in clinical roles (IV drug administration, Defibrillator, etc) Ensures each team member is present and each Code Role is fulfilled and armbands are applied.Ensures arm bands are visibleEnsures availability of work space for team membersManages crowd control with SecurityOrganizes additional resources/equipment as needed (Code Pink +/- Neo Resus & emergency delivery equipment)Assigns staff member to stay with familyNotifies (or delegates) Social Worker, Chaplain, Interpreter Coordinate transfer of patient to alternate facility via PTN or LDR, OR, High Acuity Service (HAS) at the direction of the team LeaderCoordinate transfer of visitor to alternate facility (911 via BCEHS) at the direction of the team leader Compressors #1-3 -BLS skill- unit staffApply COMPRESSOR armbandProvides high quality chest compressions using Adult size Zoll pads per ACLS protocolsRotates out of position every two minutes or sooner if fatigued.Facilitates immediate exchange with other delegated compressorsReceives feedback from CPR Coach to ensure highest quality of CPR is being performedRunner #1 & 2 -Unit staff- as familiar with areaApply RUNNER armbandReceives instructions from Code Team Lead or delegateUses closed-loop communication and clearly states “I am getting…”When returns clearly states “I have brought…”Integrated Protection Services -SecurityAttend all Code Blue calls & provide support for the Code Blue TeamAssist with wayfinding for staff, BCEHS and other patients/visitorsPerform Access/Crowd Control to ensure the Code Blue Team is unimpeded If directed by Code Blue team, assist in contacting Switchboard to notify BCEHS (9-1-1) If required, provide an escort for any additional Emergency Medical Responders that may attendAfter the Event Roles and Responsibilities of the teamAll MembersVerifies and signs the Resuscitation Record (RR) with designation Team Leader May perform team defusing post-code for learning and improvement (e.g. Take 5) BCW RTEnsure Crash Cart is replenished after the eventIV/IO Medication #1Brings emergency drug bag, intubation drugs and EZ-IO drill kit back to unit, restocks and reorders supplies to ensure backpack contents are completeRecorderEnsures Resuscitation Record is completeEnsures Team Leader reviews and signs the Resuscitation RecordParticipates in Take 5 and prompts Team Leader conduct Take 5 Complete and sign Resuscitation Record (RR) and gives to the CNL to deliver to 2N13 Quality and Safety Leader Maternal Newborn Program-When the victim is a patient, the original white copy of the RR remains in the patient’s Health Record -When the victim is a visitor, the original white copy of the RR is provided to BCEHS to go with the victim-The yellow copy of the RR goes to the chair of the BCW Adult Code Committee (Quality and Safety Leader for Maternal Newborn Program)Event Manager Participates in defusing (e.g. Take 5) and ensures completion of documentation with Team Leader and RecorderDelivers copy of code documents to Code committee representative (2N13 Quality and Safety Leader Maternal Newborn Program)Ensure completion of PSLSDetermine need for CISM and Initiate CISM Notification Checklist, notify PM as appropriateReferences American Heart Association. (2019). Highlights of the 2019 Focused Updates to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care- Heart & Stroke Foundation of Canada Edition. British Columbia Center for Disease Control. (2016). Decision support tool: Administration of naloxone. Columbia Women’s Hospital & Health Center. (2020). COVID-19: Adult Code Blue Events. Columbia Women’s Hospital & Health Center. (2019). Seizure protocol algorithm. 's %20Hospital%20-%20Fetal%20Maternal%20Newborn/C-06-13-60149%20Seizure %20Protocol%20Algorithm.pdf British Columbia Children’s and Women’s Hospital & Health Center. (2020). Naloxone administration (without an order) for suspected opioid overdose: Nurse independent activity (NIA) (Procedure). Columbia College of Nursing Professionals. (2017). RN scope of practice. , M.E., Brennan, E. E., Goldberg, Z.D., Swor, R.A., Terry, M., Bobrow, B.J., Gazmuri, R.J., Travers, A.H. & Rea, T. (2015). American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care Part 5: Adult basic life support and cardiopulmonary resuscitation quality. Resuscitation. 132(18)(s2): S414-S415. M.S, Berkow, L. C., Kudenchuk, P. J., Halperin, H. R., Hess, E. P., Moitra, V. K., Neumar, R. W., O’Neil, B. J., Pacton, J. H., Silvers, S. M. White, R. D., Yannopoulos, D. & Donnino, M. W. (2015). American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care Part 7: adult advanced cardiovascular life support. Resuscitation. 2015. 132(18)(s2): S444-S464 Health Care. (n.d.). Decision support tools emergency cardiac care: Provincial guidelines and tools for Registered Nurses. Health Care and Vancouver Costal Health. (2018). Hypoglycemia, management in adults (Protocol). Provincial Health Services Authority Health Professions Act Leads (Nursing) Committee. (2019). Anaphylaxis: Initial emergency treatment by nurses (Adult & Pediatric) clinical decision support tool. ByC&W Code Blue Committee; Adult Code Blue CommitteeVersion HistoryDATEDOCUMENT NUMBER and TITLEACTION TAKEN26-Aug-2020C-0506-13-60787 C&W Adult Code Blue Team: Roles And ResponsibilitiesApproved at: C&W Best Practice CommitteeDISCLAIMERThis document is intended for use?within?BC Children’s and BC Women’s Hospitals only. Any other use or reliance is at your sole risk. The content does not constitute and is not in substitution of professional medical advice. Provincial Health Services Authority (PHSA) assumes no liability arising from use or reliance on this document.?This document is protected by copyright and may only be reprinted in whole or in part with the prior written approval of PHSA.? ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download