Here is a guide to help you, the healthcare professional, start to become a productive participant in an in-hospital emergency (code blue).
1. Call For Help Prior To A Cardiopulmonary Arrest Occurs
Yell down the hall for help, pick up the nearest phone, push the code button, and call the Rapid Response Team (RRT) or Medical Emergency Team (MET). Get help from your peers nearby as well as any code team or EMS that is on their way to help you. Call the team if you notice even subtle differences in the patient and their vital signs (including intractable pain). The RRT is to identify patient changes, call a team, and prevent clinical deterioration.
2. Know The Emergency Number To Call
Post a sign with the number to call in an emergency and the name of your location and address if one would need to call EMS (911). In the hospital there may be a code number, a code button, intercom, RRT number, family RRT number. These numbers need to be memorized as well as clearly posted. When notifying the operator to page the team, be very clear with the location of the emergency, what type of emergency (cardiopulmonary arrest, stroke code, RRT, security code, etc.)
3. Stay Calm
When you know help is already on the way, you should be able to stay calm. Once you have called for help, the team and the equipment will be on the way. Getting yourself prepared for the worst emergency situation is also a great way to prepare your self. Decide what the worst thing that could happen to your patient could be, and decide what equipment you will most likely need. For example, if your patient is having trouble breathing, have an airway and bag-mask already in the room. If the IV is not running well, restart before an emergency occurs.
4. Know How To Use Your Emergency Equipment
Before the emergency happens, you and your peers need to know where the emergency equipment is stored and how to use it properly. Know how to prepare the oxygen, suction and intubation equipment. Know what medications are in the code cart and what they are used for. This will help with your confidence in anticipating the patient’s (and team) needs.
Review the event afterwards to see what went well and what could have gone better. This includes the patient events and outcomes as well as how the team functioned together. Include the Pastoral Care or Social Work Department to help with emotional interventions for the family as well as meeting with staff members.
6. Take Notes And Document Events
Document all vital signs (V/S), treatments, and decisions, during the event, with an exact timeline as best as possible during the event. You should keep your notes, especially if there could be a liability issue associated with the emergency situation.
7. Certification And Review Courses
If you work in a procedural area of a hospital you probably should take a Basic Life Support (BLS) certification class. This class offers knowledge and skills regarding MI, stroke, chest compressions, Automatic External Defibrillator (AED), and airway adjuncts. Another great class to take is the Advanced Cardiac Life Support Course (ACLS) certification is an intense course with cardiac arrhythmias and cardiopulmonary arrest as a priority topic. ACLS includes learning and testing stations, including a lengthy written exam.
8. Be Willing To Help Others
If there is an emergency in a patient area that you are not currently assigned to, you should be quick to offer assistance. In this type of situation you can learn and gain more experience. Assist, watch, listen, and learn.
9. Know Your Patient
It is important to have all the patient’s history, blood work with any test results, and any recent changes in the patient’s status. Review the patient’s chart, listen carefully to the hand-off/report at the beginning of your shift. Do this before your hectic day begins. When the medical team arrives to the patient emergency they will have lots of questions about the patient. They will expect answers from you. Knowing these answers for the team allows for appropriate treatments, and perhaps faster and better patient outcomes.
10. Post-Emergency Or Code
The period after the code has ended is also a stressful time. It is great if the code is successful and the patient survives. However, the patient may now need a higher lever of care, and need to be transferred to a critical care area. Time is needed to document the events and the patient outcomes. Of course, this is the time that everyone thinks the code is “over” and they all leave the room. You need to make sure that the practitioner stays with you and the patient, assisting you in handling vasoactive infusions and medications while stabilizing the patient. If the patient does not survive the code, this is another time you don’t want to be alone. You want another nurse, technician, or assistant to help with cleanup and preparing the body for a family visit or for the morgue. Remember how you felt during this situation and be there for your peers, when it is their emergency situation.