Rapid Response

Code Blue / Code Stroke

D/C Huddle

Prime Healthcare Education Services

 At the completion of this lecture, the learner will be able to:
– Discuss the difference between a Code Blue/Stroke and Rapid Response
– Define Rapid Response criteria
– Recognize who can call a Rapid Response or a Code Blue/Stroke
– Explain Team Roles and Dynamics
– Identify members of a Code and Rapid Response Team
– Recognize Code Cart contents
 What’s the difference between Rapid Response and a Code?

Rapid Response
Recognizing Signs and Symptoms of deterioration in a patient’s condition
Code Stroke
AMS, one sided weakness, facial droop, slurred speech
Code Blue
Patient is unresponsive, not breathing, pulseless

“A patient’s baseline condition begins to deteriorate a mean of 6.5 hours before an unexpected critical event or
actual cardiac arrest. Seventy percent of such events are preventable. Early recognition of warning signs of
clinical deterioration and interventions by an RRT may provide better outcomes for general medical-surgical
patients” (Thomas, VanOyen, Rasmussen, Dodd, & Whildin, 2007).
Rapid Response Criteria Adult
 Acute change in heart rate to less than 40 or greater than 130
bpm
 Acute change in systolic blood pressure to less than 90 mmHg
 Acute change in respiratory rate to less than 8 or greater than
24 per minute
 New unexpected or symptomatic threatened airway or
respiratory distress
 Acute change in O2 saturation to less than 90% despite O2
 FIO2 requirements increased by 50%
 Acute decrease in level of
consciousness/mental status change
 Acute seizure
 Acute onset of chest pain
 Rapid Response Criteria: Other

 Color change (of patient or extremity); pale, dusky, gray,

blue, mottled, etc…
 Anxiousness, restlessness
 Uncontrolled bleeding
 Diaphoresis with any of the above symptoms

What is your “gut” instinct on this patient?

Does something seem “Not Right”
Who Can Call a Rapid Response or Code?
 ANY STAFF MEMBER
 THE PATIENT
– Patient’s Bill of Rights

 THE FAMILY
– Family Initiated Rapid Response
– Josie King Story
The Josie King Story
In 2001, 18-month-old Josie King died of dehydration and a wrongly-administered dose
of narcotics at a major U.S. hospital. Josie’s mother expressed concerns to the
healthcare team regarding Josie’s condition but was dismissed. It is believed that the
healthcare teams’ refusal to listen to the families concerns ultimately lead to Josie’s
death. It is important that healthcare professionals work together with families to
ensure the safety of patients.
Rapid Response Team/ Code Team
– Residents/Interns
– ACLS RN from Critical Care
Area (ER responds to 1st
floor common areas. ICU
to all inpatient settings)
– Respiratory Therapists
– Charge RN/House
Supervisor
– Primary RN
– Ancillary staff as needed
 Radiology
 Lab/Phlebotomy
 ECG tech
 Team Dynamics
Who is on the Team?
Team Leader: organizes the efforts of the group and makes sure everything gets done
at the right time in the right way.
Team Members: must be proficient in the skills for which they are trained within their
scope of practice.
Effective Communication during resuscitation:
1. Closed loop communication
2. Clear messages
3. Clear roles and responsibilities
4. Known one’s limitations
5. Knowledge sharing
6. Constructive intervention
7. Reevaluation and summarizing
8. Mutual respect
Team Roles

 Call Code or Rapid Response

 Establish an IV if one is not already present
 Stay with the patient
 Give SBAR report
 Maintain the patient’s privacy
 Designate someone to record
 Don’t forget about the family- must be
notified when there is a change in condition
What happens during a Code Blue
 Check to make sure immediate area is safe
 Begin CPR immediately- Stay calm, remember BLS and
call for help
 Waiting for the team…
 Get the crash cart! Crash cart should also have a Defib
Monitor and an Respiratory box
– If your area does not have a code cart, someone will bring one

 Provide privacy
 SBAR Report / Get chart, open chart in computer
 Reassure family/visitors
Not Just For Patients…
Code Blue or Rapid Response can be anywhere!
 Radiology
 Laboratory
 Cafeteria
 Pharmacy
Code Blue or Rapid Response can involve anyone!
 Cardiac Rehabilitation…
• Employees
• Volunteers
• Outpatients
• Visitors
• Students
Adult Code Cart

Contents on Crash Cart

– ACLS Algorithms – Gel Pads (1 Package)

– Monitor/Defibrillator – Chest Electrodes (3)
– Respiratory Box – Emergency Cart
– Ambu Bag Contents
– Multifunction Adult – Code Blue/Flowsheets
Defib. Electrodes (2) – Code Cart Contents and
Daily Checklists
Adult Crash Cart Contents

 Immediate Supplies
 Medications
 Monitor Supplies
 Syringes
 IV Equipment
 IV Solutions
 Special Supplies
Why do we use the Broselow™ Tape?
In emergency situations, time is critical. Tasks are usually performed under stress, therefore
potentially increasing the chance of errors. The Broselow™ tape is used to estimate a child’s
weight, calculate medication dosages, and identify appropriate sizes of equipment (e.g.,
endotracheal tubes) quickly and efficiently which can simplify decision-making and reduce the
risk of clinical errors during CPR.

The Broselow™ Tape is placed alongside a child who is lying on a flat surface in a supine
position. The tape contains color-coded sections (“color zones”) that estimate the weight of
a child whose length (i.e., height) falls within that section. Each color zone lists correct
medication dosages and equipment sizes for a child of that length
 Facility Specific Information

 If a RRT is identified, dial 3333 on the hospital

phone and tell the operator there is a Rapid
Response/Code Stroke/Code Blue in room
___
– Operator will page overhead to mobilize the teams
 Facility Specific Information
 All code/RRT documentation can be found in FormFast
– Physicians MUST SIGN the flowsheet prior to leaving

 All orders should be placed in real time when possible

 Physician progress note documentation under critical care
medical
 All expirations are referred to Gift of Life and need to be
documented in SORIAN
 Post RRT/Code Blue debrief
 Discharge Huddle
 Objectives:
– Care co-ordination
– Throughput efficiency
– Decrease length of stay
– Communication efficiency
– Identifying barriers

 Expectation:
– Attending daily Huddle @10:30am
– Know your patients
– Speak up about your challenges
– D/C order to be placed and completed by 12 noon
– E-Prescribe meds to pharmacy to support “meds to bed program”
 Conclusion
 Who can call a Rapid Response?
 What signifies a Code Stroke?
 What do you do if you were assigned a role you are not trained in
during a Rapid Response?
 End of Slide Show

Questions?