POLICY This policy outlines the paging codes and expected response times for team communciation during obstetrical emergencies and routine maternal/newborn care at BC Women s Hospital. Applicability: This policy applies to the Diagnostic Ambulatory and Acute Perinatal Programs. This policy does not apply to the Code Blue or Neonatal Resuscitation teams. PROCEDURE 1.0 Code PINK Assessment indicates a woman/ fetus life is in imminent danger. The Code Pink team is requested to attend immediately without pausing to return the call. Switchboard test of CODE PINK occurs at 20:00 daily Examples of Obstetrical Emergencies (to call CODE PINK) include but are not limited to: Level 2 PPH Prolapsed cord Preterm delivery on Antepartum Shoulder dystocia Severe APH with accompanying signs of Undiagnosed breech delivery fetal distress Uterine rupture How to call Code Pink Dial 33 and State: 1) Code Pink 2) Building 3) Department & physical location 4) ASK OPERATOR TO REPEAT INFORMATION Team Member: The Code PINK team consists of a specialized Obstetrical team able to manage obstetrical related emergencies for the Acute Perinatal Program at BC Women s Hospital. The team has the ability to initiate emergency delivery processes, activate additional teams, stabilize the patient and transfer patient to appropriate location ( LDR/HAU/OR) for further asesssment. *In the event a second Code Pink is called, the team members who have TAPPED OUT will attend. If the entire team is unable to respond to the second Code Pink, Team lead will request that a Code Blue is activated to respond to the second Code Pink The team consists of: Second RN (SRN) Level 1 and on-site OB On-site OB resident Anesthesiologists on call for LDR Anesthesiologists on call for emergencies Anesthesiologist resident Respiratory Therapist Anesthesiologist Assistant during day hours Monday to Friday Clinical Nurse Leader (CNL) Perinatal Clinical Educator (PCE) /Clinical Resource Nurse (CRN) Page 1 of 5
Roles and responsibilities of team member: Team Leader: Level OB or On-Site OB Identify him/herself Positioned at the foot of the bed Delegate roles and responsibilities Summarize patient care Ask for suggestions Anaesthesiologist: Lead and manage cardiopulmonary resuscitation Identify him/herself Positioned at the head of the bed Delegate role and responsibilities to Respiratory Therapist & Anaesthetist Assistant Insert airway Direct the administration of drug therapy Summarize interventions provided Respiratory Therapist: Assist anaesthesiologist with airway management and ventilation Manage airway, ventilation and oxygen therapy Anaesthetic Assistant (AS): Assist anaesthesiologist with airway management and ventilation Monitor and insert IV Administer drug therapy as per anaesthesiologist direction Manage airway, ventilation and oxygen therapy Second RN (SRN): First assist to Team Leader Monitor vital signs, blood loss, uterine tone Assess patient responsiveness to treatment Communicate finding to Team Leader Communicate finding to Primary RN Primary RN: Provide SBAR to Code Pink Team Leader on arrival Responsible to Document: 1) Patient status: respiration, O2 saturation, heart rate, blood pressure, blood loss 2) Interventions 3) Drugs (type, dosage, route and time) Communicate loudly and directly to Team Leader: 1) Drugs given 2) Summarize interventions given Page 2 of 5
Clinical Nurse Leader (CNL): Coordinate transfer of patient to OR or HAU if required Complete Code Pink Record Call Switchboard to inform operator when the Code is finish Complete PSLS Perinatal Clinical Educator (PCE) & Clinical Resource Nurse (CRN): Assist SRN and Primary RN 2.0 STAT CALL Assessment indicates an emergency concern for the woman/ fetus/ newborn s current health status. The STAT page indicates that the Primary Care Provider been paged is requested to attend immediately without pausing to return the call within 5 minutes. If Primary Care Provider is not present at patient bedside after 5 minutes of being paged, page the On-site OB for maternal concerns and on-call Pediatrician for newborn concerns. How to call STAT call Dial 33 and State: 1) STAT 2) Person (e.i. OB level 1, OB onsite, Anesthesiologist, Pediatrician) 3) Building 4) Department & physical location 5) ASK OPERATOR TO REPEAT INFORMATION Examples of STAT situation which include but are not limited to Maternal: Prolonged bradycardia Level 1 PPH Imminent Delivery Hypotension Arrhythmias Respiratory distress Significant change in patient condition requiring immediate assessment Newborn: Newborn Respiratory Distress 3.0 Routine Page (for all other pages) Assessment indicates standard assessment or adjustment in care plan and/or monitoring of woman/ fetus/ newborn. PCP requested to respond to page the within 10 minutes and attend within 60 minutes How to call: Dial 2161 and State: 1. Name 2. Confirm Primary Care Provider on call; 3. Building 4. Physical location 5. ASK OPERATOR TO REPEAT INFORMATION Examples of Routine Page situation which include but are not limited to: Maternal Newborn Discharge orders Discharge orders Adjustment to medication Adjustment to medication Update Primary Care Provider Update Primary Care Provider Page 3 of 5
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DOCUMENTATION Document on the chart all attempts to notify the care provider: Interprofessional Progress Notes Physician s History and Progress Notes Triage and Assessment Record SBAR Tool Delivery Suite, Postpartum, and Antepartum Page 5 of 5