Grey Nuns Community Hospital EMERGENCY RESPONSE CODE BLUE Cardiac Arrest / Medical Emergency Acute Care

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Georgiana Burke
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Grey Nuns Community Hospital EMERGENCY RESPONSE CODE BLUE Cardiac Arrest / Medical Emergency EMERGENCY RESPONSE CODE BLUE ALGORITHM First Person On-Scene If the First Person On-Scene is able to

1 Grey Nuns Community Hospital EMERGENCY RESPONSE CODE BLUE Cardiac Arrest / Medical Emergency EMERGENCY RESPONSE CODE BLUE ALGORITHM First Person On-Scene If the First Person On-Scene is able to proceed with activation of the emergency response, they are to continue in the First Responder role (see First Responder algorithm, below) If the First Person On-Scene is not able to proceed with activation of the emergency response, they are to call for HELP and stay with the person requiring assistance until a First Responder arrives First Responder Upon discovery of a person requiring assistance for a medical emergency: Verify scene safety, perform point of care risk assessment (put on PPE, as required) o Is the scene safe? o Are there multiple persons requiring assistance? Is the person unresponsive? Call for nearby HELP Look for no breathing or only gasping breaths and check pulse (simultaneously) o Is a pulse definitely felt within 10 seconds? and/or Are there other life threatening conditions (e.g. significant bleeding) or obvious injury (e.g. C-spine) requiring immediate care or protection If known, verify any Advance Care Planning and Goals of Care Designation (ACP/GCD) to confirm resuscitation status* If a Code Blue response is indicated by ACP/GCD or their designation is unknown: Activate Site Code Blue response [e.g. depressing Code Blue button, pulling call bell, depressing duress button, dialling emergency number 66#]; and If indicated, initiate Basic Life Support (BLS) procedures If a Code Blue response is not indicated by the patient s ACP/GCD, or where the patient s acute condition do not require immediate intervention: Activate the most appropriate level of response and support Page 1 of 8

2 EMERGENCY RESPONSE CODE BLUE ALGORITHM Second Responder If not completed by the First Responder, and where a Code Blue has been determined to be appropriate: Activate Site Code Blue response [e.g. depressing Code Blue button, pulling call bell, dialling emergency number 66#] Bring backboard, airway management supplies or local emergency cart to the patient location, where available. Ensure paediatric equipment is available for patients less than 18 years of age Assist with BLS procedures. Continue life support measures until the Code Team arrives If a Code Blue response has been determined not to be indicated: Activate the most appropriate level of response and support Unit / Area Staff Immediate Responsibilities: Assign a staff member to remain at the entrance to the area to direct the Code Blue Team to the Code Blue location Assist with BLS procedures, if indicated Assign a staff member to control pedestrian traffic in the area Provide support to family, if present Assist other persons to move away from the area Clear the route of any excess equipment or supplies for the Code Blue Team arrival Refer to APPENDIX 1 for other duties to support the Code Blue Team *If Switchboard Services is not on-site, these duties are to be reassigned Unit Staff Switchboard / Designate* In accordance with the Site s First Response to a Medical Emergency plan, upon receiving notification of an incident: If the incident location is outside of the site s defined response locations for the Code Blue Team o Direct the caller to dial 911 to activate Emergency Medical Services o Notify the site s designated first responders, providing the location of the incident If the incident location is within the site s defined response locations for the Code Blue Team, in accordance with established processes, advise all staff Code Blue / Location (three times) Page 2 of 8

3 EMERGENCY RESPONSE CODE BLUE ALGORITHM Code Team Members The composition of the Code Blue Team, and resources available, will be determined by each Site. A generic guide to Code Team membership, responsibilities, and expectations is attached as APPENDIX 1. This information is to be amended to reflect the individual site response plan. *If Protective Services is not on-site, these duties are to be reassigned Unit staff Protective Services / Designate* Respond to all Code Blue calls or telephone the Code Blue location to determine whether they are required to attend In the event of a Unit, building, or site lockdown, Protective Services is to attend the ICU to be on stand-by, in anticipation of a Code Blue, ready to provide escort or gain approval for the Code Blue Team (from attending Police Services) to respond to the Code Blue location Assist with way-finding Assist with control of pedestrian traffic and safety concerns Supervisor / Designate of Area Assist and direct staff responding to the medical emergency (see APPENDIX 1) Gather information from staff discovering the incident Confirm Code Blue has been activated Ensure physician and patient s family are made aware of the incident Ensure Program Management is notified Arrange for staff support as needed (e.g. Employee & Family Assistance Program [EFAP], etc.) Ensure incident documentation is completed by staff (see POST INCIDENT ACTIONS) In consideration of staff and physicians impacted by the incident, engage or suggest engagement of EFAP, PFSP, and other supports (see Post Incident Actions, which follows) Page 3 of 8

4 Site: Grey Nuns Community Hospital Approval Level: Covenant Health E/DM Cross Reference: Document #: ERC 1a Initial Effective Date: February 2018 Revision Effective Date: February 2018 PURPOSE is the designated phrase to provide guidelines and direction on how to respond to any person experiencing acute physiologic compromise, airway threat, respiratory and / or cardiac arrest. A Code Blue is to be initiated for acute physiological disturbances that require immediate intervention and has Resuscitative Goals of Care R1, 2 or 3 or unknown Goals of Care. 1 This plan forms a general template, as a guide for each Covenant Health site to utilize. It is essential that the plan be site specific. Individual work sites may need to add (or delete) items that are specific to their operation. 2 APPLICABILITY Compliance with this Emergency Response Code is required by all Covenant Health employees, members of the medical and midwifery staffs, students, volunteers, and other persons acting on behalf of Covenant Health (including contracted service providers as necessary). This plan does not limit any legal rights to which you may otherwise be entitled. 3 ACTIVATION can be initiated by any member of staff or physician who performs the initial assessment of the patient s condition. POST INCIDENT ACTIONS In addition to the actions outlined in the algorithm, the Supervisor / Designate of the area is to: 1 AHS Policy # HCS-38 - Advance Care Planning and Goals Of Care Designation 2 OHS Code Explanation Guide, published by Alberta Queen s Printer for the Alberta Government 3 Section 35 of the Alberta OH&S Act states that: (1) No worker shall (a) carry out any work if, on reasonable and probable grounds, the worker believes that there exists an imminent danger to the health or safety of that worker, (b) carry out any work if, on reasonable and probable grounds, the worker believes that it will cause to exist an imminent danger to the health or safety of that worker or another worker present at the work site, Page 4 of 8

5 Implement subsequent emergency response plans as appropriate If any Staff sustained a blood and body fluid exposure (BBFE) or are reporting that they have been impacted by the incident, ensure the following are completed: o Report through Covenant Health Occupational Health and Safety o Arrange for staff support as needed (e.g. Employee & Family Assistance Program [EFAP]), in consultation with OHS and Site Leadership Physicians impacted by the incident may seek support through the Alberta Medical Association s Physician Family Support Program (PFSP) Ensure clinical documentation is completed as follows: o Documentation of events preceding the Code Blue up and until the time the Code Team arrives, including incident documentation in the Reporting & Learning System for Patient Safety (RLS) o Other site or Covenant Health-specific documentation as appropriate Ensure incident documentation is completed. This may include: o Other site or Covenant Health-specific documentation as appropriate REFERENCE Policy I-25, Emergency/Disaster Management Response Heart and Stroke Foundation, Basic Life Support (BLS), 2015 Page 5 of 8

6 APPENDIX 1: CODE BLUE TEAM RESPONSIBILITIES AND EXPECTATIONS IPC Considerations: Hand hygiene may not be reasonably performed prior to care, but must be performed after care PPE must be donned prior to care or as soon as practically possible. Gloves must be worn by the team. Health care workers (HCW) at or within 1 metre of the patient s airway must wear a mask and eye protection. Code Blue Team Composition: 1. Code Blue Team Physician Lead a) A physician, who has sufficient knowledge and training to lead an adult or paediatric resuscitation, will direct the Code Blue Team and be responsible for the overall management of the resuscitation b) The role of the Code Blue Team leader may be delegated to another more experienced physician team member at any time c) Code Blue Team lead signs the Cardio-Respiratory Arrest Record to authorize all verbal orders given, and procedures carried out during management of the Code Blue by the Code Team d) Code Blue Team lead is to arrange for transfer to appropriate area when necessary, and remains with the Code Team until the patient is transferred e) If resuscitation attempts are unsuccessful, it is the Code Blue Team leader s responsibility to terminate the resuscitation efforts 2. Code Blue Team Registered Nurses a) Ensures necessary equipment is available Brings the crash cart as required b) Co-ordinates / delegates roles Manages crash cart: prepares medications, mixes intravenous solutions, manages defibrillator, etc. Documentation: Signs the Cardio-Respiratory Arrest Record upon completion of the Code Blue. When documentation is delegated to another health care professional, Code Blue nurse is responsible to review documentation with recorder and to ensure that the Cardio- Respiratory Arrest Record is completed accurately and signed by appropriate personnel Patient Care: remains at the Code Blue scene, with crash cart, until resuscitation is discontinued or de-escalated and the patient is either determined to be stable to remain in the same location or needs to be transferred to a more appropriate area Page 6 of 8

7 3. Registered Respiratory Therapists a. Manages the patient s airway, oxygenation, and ventilation b. Assists with endotracheal intubation or, if certified, performs endotracheal intubation in the absence of, or as directed by, the Physician Lead c. Responsible for ensuring the difficult airway management equipment is available d. Assists with external cardiac compressions e. Confirms successful intubation with a secondary device (end tidal carbon dioxide or esophageal detection device) f. End tidal carbon dioxide confirmation of airway is required on all patients with an endotracheal tube, even if one is in place prior to arrival of the Code Blue Team, and will be documented on the Cardio-Respiratory Arrest Record g. Cuts the wires for patients with jaws wired to manage airway and ventilation h. Performs blood gas sampling and analysis. i. Remains at the Code Blue scene, with crash cart, until resuscitation is discontinued or the patient is transferred to an appropriate area j. Signs Cardio-Respiratory Arrest Record and ensures that the tasks they have performed are documented accurately k. Responsible to restock and replace any used airway management supplies 4. Unregulated healthcare providers a. Assists with bringing the crash cart to the site of the Code Blue b. Performs chest compressions as directed c. Assists with transport of patient after the code, as necessary d. Assists with crash cart cleaning and replacement as directed 5. Patient care area staff a. Performs BLS, including establishing an airway with equipment as available until the Code Blue Team arrives b. Directs the Code Blue Team to the location of the patient c. Assists as directed throughout the resuscitation d. Ensures the patient record is in the room e. Clears any excess equipment or supplies, and assist other patients away from the area f. Support the family if they remain present g. Has the following information readily available for the Code Blue Team Patient identification and Goals of Care Designation When the patient was last seen conscious and breathing (how long have they been down) What occurred just prior to the Code Blue Reason for the patient s admission h. Contact the family and attending physician if not already present i. Accompany the patient on transport to appropriate department for a higher level of care j. Document events preceding the Code Blue up and until the time the Code Blue Team arrives k. Ensure crash cart equipment / supplies are appropriately reprocessed and restocked Page 7 of 8

8 6. Electrocardiogram / Cardiology Technologist a. Attend all Code Blue calls 7. Protective Services a. If on-site, attend all Code Blue calls or telephone the Code Blue location to determine whether they are required to attend Page 8 of 8

Banff Mineral Springs Hospital EMERGENCY RESPONSE CODE BLUE Cardiac Arrest / Medical Emergency Acute Care

Banff Mineral Springs Hospital EMERGENCY RESPONSE CODE BLUE Cardiac Arrest / Medical Emergency EMERGENCY RESPONSE CODE BLUE ALGORITHM First Person On-Scene First Person On-Scene Call for HELP Push code