ORIGINATOR: Code Blue/Pink Committee APPROVED BY: Operations Committee Medical Advisory Committee ORGINAL DATE APPROVED: May, 2002 DATE REVIEWED: April, 2012 DATE OF IMPLEMENTATION: June 29, 2012 Page 1 of 11 POLICY: Code Pink-Adolescent will be called in the event of impending/actual respiratory and/or cardiac arrest in adolescents in the age group from 13-17 years of age inclusive. Prior to termination of resuscitation efforts, if a code has been initiated on a patient, an independent double check of the patient s code status by 2 individuals using the code status recorded in the patient s electronic health record must be done. Documentation in patient chart must be completed. Code Pink-Adolescent can be activated in all areas at the General site by any member of the health care team. All code unit/department staff that are off the unit when a code is announced are required to return to their unit/department immediately. All Registered Nurses (RN) from the Child and Teen Unit and ED who respond to Code Pink- Adolescent will hold a current certificate in Paediatric Advance Life Support (PALS). Events will be recorded immediately and accurately using the Code Blue/Code Pink-Adolescent Resuscitation Record. Code Blue, Pink and Pink Adolescent polices will be reviewed during hospital nursing orientation. Workshops, online learning and educational sessions and online learning will be offered on a regular basis. It is strongly recommended that nursing staff attend at least one mock code session every year. The Code Blue/Pink Committee is responsible for reviewing the arrest procedure, auditing resuscitation record and recommending changes in process to the Adult crash cart contents. All Code Team Members must wear 4 point Personal Protective Equipment (PPE) which includes gloves, N95 mask, eye protection (goggles or face shield) and gown, in accordance with NYGH hospital policy Routine Practices and Additional Precautions http://www.nygh.on.ca/nygh-test/ip-iii-20-routine-practices-additional-precations.pdf (1) IP-VI-40 Prevention of Acute Respiratory Illness (Section D)
Page 2 of 11 CODE PINK-ADOLESCENT TEAM MEMBERS Paediatrician or delegate Emergency Physician or delegate Anaesthetist on call when available Paediatric RN In-charge or Unit Coordinator or delegate Emergency Department RN (when available) Unit Staff RN Registered Respiratory Therapist (RRT) Electrocardiogram (ECG) / Lab Technician Intravenous Therapy (IV) RN when available Porter Chaplain when available (on call Chaplain may be called if arrest occurs off hours at family s request) Social Work when available LOCATION OF CODE AND WHO RESPONDS GENERAL SITE: The Paediatrician, Paediatric RN, Emergency Physician, and ED RN respond to all Code Pink - Adolescent codes in the hospital with the exception of the Paediatric RN only attending Code Pink-Adolescent in the ED when required. The ED RN will bring the Adult Crash Cart to the location of the Code Pink-Adolescent in the non in-patient areas (i.e. first floor, lower level, and ground floor and hospital grounds) and assumes direct patient care during the code. For all other in-patient care areas the Adult Crash Cart will be brought to the scene by the Unit Staff RN where the code has been initiated. The Adult Crash Cart is retrieved from the designated location on each unit. BRANSON SITE: Refer to Policy & Procedure - Patient Care Policy # II - 39 Code Blue, Code Pink, Code Pink Adolescent Branson
ADULT CRASH CART CONTENT AND ASSESSMENT Page 3 of 11 The following equipment will to be checked by an RN/RPN to ensure that it is operational and is signed off on the equipment checklist every 24 hours and following completion of cardiac arrest (please refer to crash cart checklist located on top of the crash cart): Defibrillator Oxygen Suction Orange intubation roll and Bougie Expiry date on drug tray For CrCU and ED Crash Cart ONLY: Difficult airway box sealed GlideScope monitor and blade attached NOTE: If the number on the red tag that seals the cart does not correspond with the number on the checklist, the entire contents of the cart will be checked at that time. The crash cart contents must be checked on a monthly basis even if they remain unopened or unused. The difficult airway box must be checked and recorded by the Respiratory Therapy Technician on a monthly basis regardless of use. RESTOCKING ADULT CRASH CART AFTER CARDIAC ARREST Drugs and equipment used during the arrest must be replaced immediately upon completion of the code by the unit staff. A replacement drug tray is obtained from Pharmacy between the hours of 0800h-1900h Monday to Friday and between 0800h-1600h on Weekends/Statutory holidays. After hours, Portering Services will deliver replacement drug trays on request. The used drug tray will be returned at any time only AFTER receiving the new replacement tray. Difficult airway equipment used during the arrest must be replaced immediately upon completion of the code by the RRT. Crash carts with defibrillators will be located on each floor. The crash cart must be checked against the content list following each use. Ensure restocked cart is sealed, checklist dated, signed and the red tag number recorded. Portering Services will obtain intubation equipment (ie orange intubation roll) from the Respiratory Therapy Department.
PROCEDURE/ GUIDELINE: Page 4 of 11 A. INITIATING A CODE PINK-ADOLESCENT FOR PATIENTS INSIDE THE HOSPITAL BUILDING 1. Push the Code Button at the bedside which is directly linked to Telecommunications. 2. All units must Dial 5555 on any hospital phone (except a pay phone) stating Code Pink- Adolescent and give the general location/ patient unit or room number. 3. If a concurrent or second Code Pink-Adolescent occurs within the same hour, it will be announced by stating Second Code Pink-Adolescent and the location. An ED Physician will respond. FOR PATIENTS OUTSIDE THE HOSPITAL BUILDING Dial 5555 on any hospital phone (except a pay phone) stating Code Pink-Adolescent and give the location of the patient and then dial 9 911.
Page 5 of 11 B. MANAGEMENT OF AIRWAY EMERGENCIES Management of airway emergencies for the purpose of this policy encompasses all care necessary to deal with sudden and potentially life-threatening events involving the airway. A difficult airway is defined as the clinical situation in which a healthcare professional who is trained in advanced airway management experiences difficulty with face mask ventilation (2) (3) of the upper airway, difficulty with tracheal intubation, or both Management of airway emergencies involves the identification, assessment and use of adjunctive equipment for establishing effective ventilation, tracheal intubation, or surgical airway. INITIATING AN AIRWAY EMERGENCY Code Pink-Adolescent team members may initiate an Airway Emergency when assistance is required for management of an emergent airway. To initiate an Airway Emergency, dial 5555 for Hospital Paging/Locating and state Airway Emergency and give the location of the patient, i.e. unit and room number. Paging/Locating will: Activate the Airway Emergency procedure Announce Airway Emergency on the overhead paging system and indicate the unit and room number Place a STAT call to the Anaesthetist on call and all designated physicians with special expertise in management of a failed airway Those physicians in house will respond to the Airway Emergency In circumstances where the Anaesthetist on call or the designated physicians are not available, Paging/Locating will make an overhead announcement for any physician able to assist with an emergency airway. C. MANAGEMENT OF TRAUMA Management of trauma emergencies for the purpose of this policy encompasses all care necessary to deal with sudden and potentially life-threatening events involving trauma (cspine injury, amputation of limbs, fall from significant height, penetrating injury etc.).
Page 6 of 11 D. INITIATING A CODE PINK ADOLESCENT TRAUMA Code Pink Adolescent code team members may initiate a code pink adolescent trauma when assistance is required. To initiate a Code Pink Adolescent Trauma, dial 5555 for Hospital Paging/Locating and State Code Pink Adolescent Trauma and give the location of the patient, i.e. unit and room number. Paging/Locating will: Activate the Code Pink Adolescent Trauma procedure Announce Code Pink Adolescent Trauma on the overhead paging system and indicate the unit and room number/location One Emergency physician and Emergency nurse will respond to the call and bring equipment with them (c-spine collar, backboard) Place a call to Corporate Risk Manager and notify the Risk Manager of code pink adolescent trauma. E. RESPONSIBILITIES OF UNIT/DEPARTMENT NURSING STAFF Primary RN/RPN or first qualified person on site Assesses patient for impending or actual respiratory and/or cardiac arrest Calls for help without leaving patient Notes time of arrest Opens the airway and begins bag valve mask ventilation with 100% oxygen Initiates chest compressions if indicated RN #2 or second qualified person on site Initiates Code Pink-Adolescent dial 5555 and/ or press code button if available. Identify location and type of code Brings Adult Crash Cart to scene Applies PPE, relieves RN/RPN #1 to apply PPE Assists with placement of the board under the patient if appropriate Assists with chest compressions and ventilation including placement of board under patient RN In-Charge or Unit Coordinator Ensures documentation on the Resuscitation Record in progress Delegates tasks to unit personnel as required Ensures the patient s chart and medication administration record are readily available Notifies the attending physician Ensures room and surrounding area not overcrowded Ensures that the family/significant others are made aware of patient s condition Consults Chaplaincy/Social Worker as needed Ensures that other patients are attended to
Page 7 of 11 Ensures that the crash cart equipment and drugs are replenished immediately following the event Facilitates completion of Resuscitation Record F. RESPONSIBLITIES OF THE MEMBERS OF THE CODE PINK-ADOLESCENT TEAM Paediatrician /Emergency Department Physician (or delegates) The Paediatrician and ED physician will determine who will be Team Leader. The Team Leader will provide direction for all resuscitative measures. If the patient does not respond to treatment, the Team Leader will make the decision when to cease resuscitation efforts. On arrival, the Paediatrician/ED physician will determine who will provide direct supervision for defibrillation and medication administration. In the absence of a Paediatrician or ED Physician, the first physician on the scene will be the Team Leader. The Paediatrician/ED physician will assume this responsibility upon arrival. The Paediatrician/ED physician may delegate the role of Team Leader to the patient s Most Responsible Physician when/if that physician is available and willing to be the leader. ED RN and Paediatric RN Provides nursing expertise and consultation to team members Coordinates activities to other team members ensuring the following have been assigned/monitoring the following tasks: Airway and ventilation Chest compressions Intravenous access Venipuncture Medication preparation and administration All medications will be double checked by either two RN s or RN and Physician Defibrillation: RNs certified in the act of defibrillation will defibrillate according to the team leader/medical Directive Rhythms are monitored and communicated to the physician accordingly Registered Respiratory Therapist Establishes or assists in securing and maintaining a patent airway including intubation. Provides positive pressure ventilation Assists with transfer of patient. Anaesthetist
Page 8 of 11 Establishes or assists in securing and maintaining a patent airway including intubation Assists with resuscitation Intravenous Therapy RN or delegate Ensures patent IV route(s) is established. ECG/Lab Technician Provides ECG/venipuncture as required. Porter Provides assistance as directed by the In-charge RN Transports blood or equipment as necessary Assists with transfer of patient Chaplain (on call Chaplain may be called if arrest occurs off hours at family s request) Provides spiritual support to the family and staff when available Social Work when available Provides emotional support to family and staff when available G. DOCUMENTATION The Code Blue/Code Pink-Adolescent Resuscitation Record is completed for all patients (refer to Appendix A Code Blue/Code Pink-Adolescent Resuscitation). One copy is forwarded to the Clinical Team Manager for review and identification of any immediate issues. The white copy is filed with the patient s medical record. The Clinical Team Manager will then forward the yellow copy of the resuscitation record to the Clinical Nurse Educator of the Code Blue/Pink Committee in a timely manner for review. All staff who participated in the Code Pink-Adolescent must be listed on the Code Blue/Code- Pink-Adolescent Resuscitation Record and must sign their full name and designation. A unit based debriefing may be held on a case by case basis. A Critical incident Review (CIRP) can be requested by any staff involved in a code or by any person reviewing the code. REFERENCES:
Page 9 of 11 1. NYGH Policy and Procedure: HIGH RISK PROCEDURE Routine Practices and Additional Precautions (IP-111-20) December 2011. 2. NYGH Policy and Procedure IP-VI-40 Prevention of Acute Respiratory Illness (Section D) 3. American Heart Association 2010 Guidelines for CPR 4. Anesthesiology 2003; 98:1269 77 Practice Guidelines for Management of the Difficult Airway. American Society of Anesthesiologists. 5. Antonios Liolios, MD Airway Management in the Intensive Care Unit: The Difficult Airway Copyright 2002 Medscape.
Appendix 1 Page 10 of 11
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