~ T MOCK DRILL CHECKLIST | Ree No: DRCH/GEN/010/00 ] | ] (CODE BLL a _ nls S.No.) Parameter ‘Action Performed First Responder Responsibilities YES | NO | NA | | Definition: One who discovered the need for resuscitation? | Will be the “Team Leader” before the Code Team arrives. bs] 1 Call for help. a a = 2 | Enstire patient is flat on bed. Remove pillows and drop the head of bed sae : — [_3__[ Check for pulse. The best site for this is the carotid pulse. | [4 TStart compression. is = [TD Second Responder responsibilities: Definition: One who heard the call for the cade or the one designated by the first responder. T+ Bring the Crash-Cart Trolley and other emergency = | equipment on the site of code. 3] Secure the backboard under the patient = 1-3 Manage airway by using an AMBU bag or a pocket mask with one-way valve. _ ar | 4 Switch role with the first responder in giving chest compressions to the patient. __ A II When Code Team arrived: i T 1 Give short history of the code and possible time code H occurred. 7 [2] May be asked to do vital signs or F 3] Suctioning set up correctly. —__ oe FT ifno other responder available, first responder will be the | *Go-for” person for the code team members. = /—$ 1 Took the electrode leads and applied them to the patient | chest appropriately. i - |} Fumed on the defibrillator/monitor and noted good tracing ‘on the monitor. e Made sure needed phone ealls for arranging ambulance transfer, consultants, and diagnostic tests, family are made. a IV Nurse In-Charge responsibilities: E _ Definition: Nurse in charge at the time of resuscitation, < ‘Scanned with CamScanner= @ | | Ree No : DRCH/GEN/010/00 “ese | MOCK DRILL CHECKLIST | (CODE BLUE) | responder) | 2 | Responsible for tracking documentation. (May be delegated to first responder who will continue with charting of Code | BLUE form if the Head nurse needs to arrange for an | ambulance transfer) "1 Noted the time ofthe code (May need to confirm with first || | 4 | 7 General Observation: Pl tS Unrecponsive ab 0-56 Po bell Pulse net Redpal Priprse 6p ret record aht | call for bele-code, biale (caste fe wall For antler aba-sipe Start ope a 00. SAPs p roergencs “len cuills Cras cat Gmived at? Sppo As pee loctees | Orel“ mechieahin Steated » + Pk nor resporelirf (Recheeked Pulse ane! reqprectin )- Corhnue ¢pR Observations Made By = - Aig oes ah epee ees one | ae i & alata hespilel at 3 Spry - Forfea . e ae Unclerhee. Ue Pacer Conelhin tt axl Is Skble -The cocte blne Proceeclare a J ended ak 205m. (Prepared By |S F “Approved By_ [Ms Malar ‘Scanned with CamScanner