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ANTIQUE MEDICAL CENTER

San Angel, San Jose, 5700 Antique


NURSING SERVICE
POLICIES AND PROCEDURES
APPROVED BY:

PAGE:

SECTION:

DATE:
POLICY ON CODE BLUE MANAGEMENT

POLICY STATEMENT
The Code Blue Team shall respond to all Code Blues that are called within the hospital.
DEFINITION
A Code Blue is the term used to alert the Code Blue team (Resuscitation team) to an area
where a person has had a cardiac or respiratory arrest.
PURPOSE OF POICY
The purpose of the Code Blue Team is to assure the prompt and skilled cardiovascular and
cerebral resuscitation of persons who suffer a cardiopulmonary arrest. The formation of a
Code Blue team shall provide for trained personnel and relieve other hospital staff
members of the responsibilities of attending Code Blues.
PROCEDURE
INVITATION OF A CODE BLUE
1. A Code Blue will be initiated on all patients, visitors and staff suffering a cardiac or
respiratory arrest.
2. If the arrest is unwitnessed nursing and/or medical staff may use their discretion to
call a code if the unwitnessed period is clinically assessed to be brief.
2.1. Exceptions are those patients who have an advance care directive or resuscitation
care plan directing otherwise, ie DNR.
3. Should a cardiac or respiratory arrest occur in a unit and it is deemed that the
appropriate personnel and equipment are currently present to provide BLS/ACLS, a
general code bluecall might not be initiated.
4. Staff trained in the use of the LifePak 20 Automatic External Defibrillator (AED)
function, may initiate AED use prior to the arrival of the Code Blue Team.
PROCEDURES DURING A CODE BLUE
The Code Blue Team shall adhere to the current Basic Life and Advanced Life Support
Guidelines.

PROCEDURE GOVERNING CHEST COMPRESSIONS


High quality chest compressions and ventilation should be carried out by the first
qualified person on the scene after ensuring that a Code Blue has been activated.
Thereafter, the responsibility will be directed by the Attending Physician. In the absence of
the Attending Physician, the Resident on Duty will make the calls.

ANTIQUE MEDICAL CENTER


San Angel, San Jose, 5700 Antique
NURSING SERVICE
POLICIES AND PROCEDURES
APPROVED BY:

PAGE:

SECTION:

DATE:
POLICY ON CODE BLUE MANAGEMENT

PROCEDURE GOVERNING DEFIBRILLATION AND CARDIAC RHYTHM MONITORING


Defibrillation of the patient should be administered by the first ACLS trained person.
Thereafter, the responsibility will be directed by the Attending Physician or his designate.
ANTICIPATING AND ASSISTING IN A CODE
1. Know your patients:
1.1. Determine the reasons for seeking admission and their working diagnosis.
1.2. Make frequent rounds to assess condition of patients.
2. Classify patients in the unit and give priority to cases such as:
2.1. Unstable cardiopulmonary cases ex. CHF, acute MI with hemodynamic
problems, COPD.
2.2. Septic patients.
2.3. CVA with pulmonary problems.
2.4. Post-op patients who underwent special procedures.
2.5. Patients on ventilators & with other gadgets.
3. Assign knowledgeable/skilled staff to handle difficult cases that need constant
monitoring and assessment.
4. Call for the Supervisor/Head Nurse to reassess patient when in doubt.
5. Refer to ROD at once if there is any erratic change in the condition of the patient
such as:
5.1. Abrupt changes in the vital signs increase or decrease in BP, HR, RR and
any irregularities in rhythm.
5.2. Sudden change or deterioration in patients sensorium.
5.3. Inadequate output with signs of pulmonary edema or fluid retention.
5.4. Restlessness, cyanosis, difficulty of breathing.
5.5. Any neurologic deficit, seizure, twitches or gait disturbances observed.
5.6. Be sure that all equipment, supplies, E-Cart are complete and ready at all
times.

ANTIQUE MEDICAL CENTER


San Angel, San Jose, 5700 Antique
NURSING SERVICE
POLICIES AND PROCEDURES
APPROVED BY:

PAGE:

SECTION:

DATE:
CODE BLUE MANAGEMENT

WHEN TO CALL FOR CODE & URGENT REFERRAL


1. Call for CODE when patient is in actual cardiopulmonary arrest unless specified
as DO NOT RESUSCITATE or DNR
1.1. CODE BLUE for patients in actual CP arrest that needs intubation.
2. Call for STAT or NOW when referral is urgent.
2.1. Patient has cold clammy skin with irregular heartbeats and decreasing blood
pressure.
2.2. Restlessness, cyanosis and difficulty of breathing.
2.3. Case of seizure.
2.4. Blood pressure persistently drops but heart rate is palpable.
2.5. Massive bleeding.
3. How to call for CODE & urgent referral:
3.1. CODE call dial Local 0 or Local 117 for Operator, to page for CODE as
indicated, mention the unit where the Code is. (e.g., CODE BLUE to Floor 2
[3x])
3.2. Urgent referral dial Local 0 or Local 117 and tell operator to page for the
particular doctor. (e.g,. Dr. dela Cruz to ICU NOW.
4. Composition of the CODE TEAM:
4.1. Ward ROD
4.2. Nurse Supervisor/Head Nurse
4.3. Charge Nurse
4.4. Staff Nurse
4.5. Nurse Auxiliary
4.6. Chaplain (for Catholic Patients)
4.7. Orderly
4.8. Respiratory Therapist
4.9. Central Supply Staff

ANTIQUE MEDICAL CENTER


San Angel, San Jose, 5700 Antique
NURSING SERVICE
POLICIES AND PROCEDURES

APPROVED BY:

PAGE:

SECTION:

DATE:
CODE BLUE MANAGEMENT

WHAT TO DO IN ANTICIPATION FOR CODE


1. Standby Oxygen to room with complete accessories.
2. Position E-Cart nearest to the patients bed.
3. Standby suction apparatus and have it ready at bedside with sterile water, suction
catheters, drainage bottle and sterile forcep.
4. Take out resuscitator bag with mask and oxygen connector and have it ready at the
bedside with airway.
5. Check and take out intubation set with complete contents.
6. Provide cardiac board.
7. Provide emotional and moral support to the family and see to it that the Sacrament
of the Anointing of the Sick was done by the priest for Catholic patients.
RECORD OF CODE BLUES
The events of the Code Blue shall be recorded on the Cardipulmonary Resuscitation
Record, see attached. This form shall be completed by the Staff Nurse to document the
actions. The flow sheet is placed in the patients chart.
DEFINITION
The term Code Blue will be used to summon a team of trained medical personnel to
undertake the cardiopulmonary and cerebral resuscitation. All physicians and nurse
members of the Code Blue Team will be trained and current ACLS Providers.
cardiopulmonary and cerebral resuscitation implies the use of accepted techniques of
oxygenation, airway management, cardiac arrhythmia recognition, cardiac defibrillation
and drug support of perfusion in an orderly attempt to restore spontaneous
cardiopulmonary and cerebral function, and external cardiac massage.

ANTIQUE MEDICAL CENTER


San Angel, San Jose, 5700 Antique
NURSING SERVICE
POLICIES AND PROCEDURES
APPROVED BY:

PAGE:

SECTION:

DATE:
CODE BLUE MANAGEMENT

WHAT TO DO IN ACTUAL CARDIO-PULMONARY ARREST


If CP arrest is recognized, institute necessary measures as follows:
1. Assess Patient.
1.1. If safe to do so, tap or squeeze shoulder.
1.2. Ask loudly, Are you, okay?
1.3. Use patients name if you know it.
1.4. For infants, try tapping foot.
1.5. Look quickly at face and chest for normal breathing.
2. Call for help but never leave the patient. Instruct companion to call for CODE
BLUE. Place patient in supine position, head of bed flat with cardiac board in
place.
3. Check for an obvious carotid pulse in neck. Take no longer than 10 seconds.
4. Start CPR.
5. Give 30 Chest Compressions
5.1. Place heel of one hand on center of the chest. Place heel of second on top of
the first.
5.2. Using upper body weight, push hard, at least 2 inches in depth.
5.3. Push fast, at least 100 times per minute. Allow chest to fully rebound.
5.4. Minimize interruptions.
6. Establish an open airway.
6.1. Prepare the necessary materials for assistive ventilation.
6.2. Utilize the bag-valve mask to give rescue breaths.
6.3. Deliver oxygen at 10Liters per minute.
6.4. Perform the head-tilt chin-lift maneuver to open the airway. When the
potential for a neck injury exists, a jaw thrust can be done. Bring face up into
mask to create an airtight seal.
6.5. The use of an oropharyngeal airway is highly recommended with a bag-valve
mask to help maintain an open airway.
6.6. When an advanced airway device is in place, attach the bag directly to the
airway device to ventilate. Squeeze bag to deliver breaths. Each breath should
be 1 second in length
7. Repeat Cycles
7.1. Provide continuous cycles of 30 compressions and 2 rescue breaths.
8. Continue CPR until CODE team arrives.
9. Have intubation set ready near head part.
10. Have Epinephrine, Atropine, Lidocaine, Dopamine ready for administration these
are major drugs important in emergency situation.

ANTIQUE MEDICAL CENTER


San Angel, San Jose, 5700 Antique
NURSING SERVICE
POLICIES AND PROCEDURES

APPROVED BY:

PAGE:

SECTION:

DATE:
CODE BLUE MANAGEMENT

NURSING ROLES DURING A CODE


1. HEAD NURSE/ SUPERVISOR
1.1. Regulates the flow of people in the area;
1.2. Checks if additional manpower is needed;
1.3. Circulates for other things needed like additional medicine not available in the
crash cart;
1.4. Informs the attending physician;
1.5. Calls the chaplain/priest if patient is a Roman Catholic & was not yet
anointed;
1.6. Maintains and organizes environment for CODE;
1.7. Prepares and sets up defibrillator when needed; and
1.8. Helps in resuscitating the patient either by doing CPR, ambubagging or
suctioning.
2. CHARGE NURSE (CIRCULATING NURSE)
2.1. Calls the information clerk to page Code Blue at Rm/Ward_____ or ROD
urgent please at RM/ward based from initial assessment;
2.2. Brings with her the E-cart to the area;
2.3. Prepares and assists in bedside procedure such as intubation, IV insertion, cut
down, NGT insertion, Catheterization, etc.
2.4. Attaches patient to monitor and other gadgets as needed; and
2.5. Anticipates needs of doctors.
3. STAFF NURSE 1 *ASSIGNED TO THE PATIENT (MEDICATION NURSE)
3.1. Activates CODE BLUE;
3.2. Initiates CPR and performs chest compressions until the CODE BLUE Team
arrives;
3.3. When the team arrives:
Administers medicine ordered by the ROD or AP; and
Utilizes the Cardiopulmonary Resuscitation Record to document the event;
Does bedside monitoring;
Checks and replaces supplies used in the code.
3.4. Anticipates and prepares medications needed in the CODE:
1.2. Time of CP arrest.
2.2. Time of CODE was sounded.
3.2. Medications given.
3.5. Requests and replaces all medicines used.
3.6. Documents all medicines given in the patients chart.
*Note: All Staff Nurses assisting in an actual CODE must be knowledgeable of ECART
contents especially medicines, stock doses and preparation.

ANTIQUE MEDICAL CENTER


San Angel, San Jose, 5700 Antique
NURSING SERVICE
POLICIES AND PROCEDURES
APPROVED BY:

PAGE:

SECTION:

DATE:
CODE BLUE MANAGEMENT

NURSING ROLES DURING A CODE


7. STAFF NURSE 2
7.1. Helps in resuscitating the patient either by doing CPR, assistive ventilation or
suctioning.
7.2. Anticipates other needs in the CODE;
8. NURSE AUXILIARY
8.1. Gets the suction machine from the CS.
8.2. Assists the circulating nurse as needed.
8.3. Run errands as needed.
8.4. Maintains and organizes environment.
8.5. Anticipates other needs in the CODE;
9. CSSR AIDE
9.1. Brings along with her the defibrillator to the area.
9.2. Brings along other equipment such as cardiac monitor, ecg machine, when
needed;
9.3. Obtains cardiac rhythm strips; when ordered.
9.4. Does errands to get other supplies needed.
10. ORDERLY
10.1. Prepares oxygen supply for patient use;
10.2. Alternately helps Staff Nurse 2 or other members of the team in doing chest
compressions or assistive ventilation;
10.3. Observes cleanliness and orderliness of the area

ANTIQUE MEDICAL CENTER


San Angel, San Jose, 5700 Antique
NURSING SERVICE
POLICIES AND PROCEDURES
APPROVED BY:

PAGE:

SECTION:

DATE:
CODE BLUE MANAGEMENT

IF
1.
2.
3.

PATIENT IS REVIVED:
Maintain continuous monitoring and assessment;
Keep accurate records of vital signs, I & O and assessment done;
Request for necessary equipment needed as ordered such as ventilator, cardiac

monitor, etc; and


4. ICU reservation must be done if patient will be transferred in the unit.
*Note: If CPR failed, doctors decision to terminate CPR upon consultation with the
family must be followed.
WHAT TO DO IN CASES OF DEATH
1. Allow the relatives to see the body for a few minutes if they want to.
2. Close the room or provide screen if in the Ward, for privacy and not to disturb
other patients.
3. Give instruction to relatives on what to do:
3.1. Arrange for the funeral parlor.
3.2. Sign some papers at the Information Desk for the release of the cadaver.
3.3. Inform the relatives that the body can be released even without final
settlement but DEATH CERTIFICATE cannot be issued unless final
arrangement has been made with the Accounting Department.
3.4. Get the clearance from the Nurses Station as soon as accomplished.
4. Do postmortem care.
5. Do usual procedure of replacing item used, notifying physicians concerned,
supervisors, information and Accounting Department.
6. Accomplish clearance form and notice of death.
7. Complete documentation in the CPR Record Form and the Nurses Notes and check
that everything has been signed.
8. Forward patients chart, once completed, to the information and have it received by
the Information Clerk.

ANTIQUE MEDICAL CENTER


San Angel, San Jose, 5700 Antique
NURSING SERVICE
POLICIES AND PROCEDURES
APPROVED BY:

PAGE:

SECTION:

DATE:

CODE BLUE MANAGEMENT


CODE BLUE TEAM
1. Ward/ER Resident on Duty
or Attending Physician

2. Head Nurse/Supervisor

3. Charge Nurse
(Circulating Nurse)

ROLES/RESPONSIBILITIES
Gives orders;
Performs endotracheal intubation;
Informs and appraises relatives of the
patients status and prognosis; and
ROD - Informs and updates the A/P regarding
the patients status.
Regulates the flow of people in the area;
Checks if additional manpower is needed;
Circulates for other things needed like
additional medicine not available in the crash
cart;
Informs the attending physician;
Calls the chaplain/priest if patient is a
Roman Catholic & was not yet
anointed;
Maintains and organizes environment for
CODE;
Prepares and sets up defibrillator when
needed; and
Helps in resuscitating the patient either by
doing CPR, assistive ventilation or suctioning.
Calls the information clerk to page Code
Blue at Rm/Ward_____ or ROD urgent
please at RM/ward based from initial
assessment;
Brings with her the E-cart to the area;
Prepares and assists in bedside procedure
such as intubation, IV insertion, cut down,
NGT insertion, Catheterization, etc.
Attaches patient to monitor and other gadgets
as needed; and
Anticipates needs of doctors.

ANTIQUE MEDICAL CENTER


San Angel, San Jose, 5700 Antique
NURSING SERVICE
POLICIES AND PROCEDURES
APPROVED BY:

PAGE:

SECTION:

DATE:
CODE BLUE MANAGEMENT

CODE BLUE TEAM


4. Staff Nurse 1
(Medication Nurse)
*Nurse assigned to the patient

ROLES/RESPONSIBILITIES
Activates CODE BLUE;
Initiates CPR and performs chest compressions
until the CODE BLUE Team arrives;
When the team arrives:
o Administers medicine ordered by the ROD or
AP; and
o Utilizes the Cardiopulmonary Resuscitation
Record to document the event;
o Does bedside monitoring;
Checks and replaces supplies used in the
code.
Anticipates and prepares medications needed in the
CODE:
o Time of CP arrest.
o Time of CODE was sounded.
o

5. Staff Nurse 2

o Medications given.
Requests and replaces all medicines used.
Documents all medicines given in the patients chart.

Helps in resuscitating the patient either by


doing CPR, assistive ventilation or suctioning.
Anticipates other needs in the CODE;

6. Nurse Auxiliary

Gets the suction machine from the CS.


Assists the circulating nurse as needed.
Run errands as needed.
Maintains and organizes environment.
Anticipates other needs in the CODE;

8. Orderly 2

Prepares oxygen supply for patient use;


Puts metered oxygen tank to the area the
soonest possible time or makes sure there is
available tank (full) for ready replacement.
Alternately helps Staff Nurse 2 or other
members in doing chest compressions or
assistive ventilation;
Observes cleanliness and orderliness of the
area

ANTIQUE MEDICAL CENTER


San Angel, San Jose, 5700 Antique
NURSING SERVICE

POLICIES AND PROCEDURES

APPROVED BY:

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DATE:
FLOW CHART: CODE BLUE MANAGEMENT

Nurses on duty conduct


initial assessment

Pages CODE BLUE


thru information
dial local 0 stating
location/room no.

CODE BLUE
Team Proceeds
to room/ward

Revived?

BP, CP, RR-O?

Perform post
mortem

Pronounced
Dead

Continue further
management

NO
Stable?

ROD conducts thorough


assessment management

NO

YES

To
Morgue
Pages ROD URGENT
Stating the room no.
/location

CODE BLUE Team


responds
Emergency
management

YES

Inform AP for further


Management