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The Role of Code Blue Teams

Andy Wijaya
PERHIMPUNAN DOKTER AHLI EMERGENSI INDONESIA
Code Blue ???

Code Blue is a declaration of or a state of


medical emergency and call for medical
personnel and equipment to attempt to
resuscitate a patient especially when in
cardiac arrest or respiratory distress or failure
UU RI No 44 tahun 2009 tentang Rumah sakit
pasal 29 ayat 1 : Pelayanan medis kedaruratan
>> Hospital Emergency Codes (Kode emergensi
rumah sakit) diperlukan diseluruh rumah sakit
untuk memberikan informasi secara cepat ,
dengan kesalahan interpretasi yang minimal
kepada seluruh staf tentang kegawat
daruratan (airway-cardiac arrest) yang sedang
terjadi
Activation
When Code Blue applies ???
1. When the person is unresponsive and has no
signs of life.
2. The staff believe that the patient, visitor or staff
member requires urgent medical attention
within 10-15 minutes.

(Code blue manual by Royal Brisbane & Womans Hospital Health Service District )
Medical Emergency Team Calling Criteria
All Cardiac and Respiratory Arrests and All Conditions Listed Below
Acute Changes in : Vital Sign
Airway Threatened
Breathing All respiratory arrests
Respiratory rate < 5
Respiratory rate > 36
Circulation All cardiac arrests
Heart rate < 40
Heart rate > 140
Systolic Blood Pressure < 90
Neurology Sudden fall in level of consciousness
(fall in GCS of > 2 point)
Repeated or Prolonged seizure
Other Any patient who does not fit the criteria above who you are
seriously worried about

To call the Medical Emergency Team Phone xxxx and tell the operator where you are

(Code blue manual by Royal Brisbane & Womans Hospital Health Service District )
Structure and Roles of Code Blue Team
Physician
as the CBT leader
Apply ACLS algorithms
Ensure good scene and crowd control
Unit/Ward RN
Initiate BLS including application of the AED
Assists the code team as needed
Give information to leader about the patient
Facilitates communication with family members
Critical Care/Emergency RN
Function as team leader until the physician arrives
Manage and monitors defibrilator and rhythm strips
Apply chest compression (CPR)
Administer medication
Documentation record
Manage the emergency trolley
Airway Manager
Provide basic and advanced airway management :
Bag Valve Mask ventilation
High flow oxygen
Suctioning
intubation

Gerganoff 2012; Code arrest/code blue management within CHN Facilities : Carondelet Health
Network
Montgomery College Hospital Simulation Lab : Code Blue team : Roles and Function, 2011
Team Position on Scene

CPR
( one or two)
Change every
2 minute
IV Nurse +
Providing safe
defibrilation
Documentation

Copied from Montgomery College Hospital Simulation Lab : Code Blue team : Roles and Function, 2011
Team Communication
Effective communication is Critical for team
working in crisis situation.
Communication ensures that everybody
knows :
what is going on,
what needs to be done,
what is already done.
REMEMBER : Communication is important to
the sender and to the receiver
A message is only communicated if it is both
SENT and RECEIVED
Meant is not said
Said is not heard
Heard is not understood
Understood is not done
Step for Communication
Closed loop communication
The leader should give an order or assignment then
confirm that the message was heard.
Team members confirm that the order or assignment
was heard
inform the leader when the task is complete.
Example:
Team Leader : Give 1 mg Epinepherine IV now
IV Nurse : 1 mg Epinepherine given IV at 9:05.
Clear messages
All messages should be delivered in a calm and direct
No yelling or shouting.
Speak clearly.
Team members should question an order if they are
unsure what was said.
Clear roles and responsibilities
Every member of the team should know his/her role
and responsibilities.
To avoid inefficiencies, the team leader should clearly

delegate tasks.
A team member should not accept assignments above
their level or competence or expertise.
Knowing ones limitations
Every member of the team should know his/her
imitations and capabilities and the team leader should
be aware of them.
A new skill should not be attempted during the arrest.
Knowledge sharing
A critical component of effective team performance is
information sharing.
The team leader can ask for other suggestions when
the resuscitation efforts seem to be ineffective.
Constructive intervention
During a code, a team leader or member may
need to intervene if an action is about to occur at
an inappropriate time.
The person recording the event may suggest that
epinephrine be given as the next drug because it
has been 5 minutes since the last dose.
All suggestions for a different intervention or
action should be done tactfully
Reevaluation and summarizing
An essential role of the team leader is monitoring and
reevaluation of the status of the patient, interventions that
have been done and assessment findings.
Mutual Respect
The best teams are composed of members who share a
mutual respect for each other and work together in a
collegial, supportive manner. All team members should
leave their egos at the door.

(Montgomery college, 2011 : Code Blue team : roles and function)


Documentation
CODE BLUE RECORD is utilized for events that
occur during the code.
The RN functioning as the recorder during the
code completes this form and attaches any
pertinent monitor strips. The original code
blue record remains with the patient record
and a copy is sent to the site specific designee
for auditing.