CHOA at Egleston Code Blue Procedures Updated November 2008 by Leah Hatfield PharmD, BCPS.

CHOA at EglestonCHOA at EglestonCode Blue ProceduresCode Blue Procedures

Updated November 2008 by Leah Hatfield PharmD, BCPS

ObjectivesObjectives

Familiarize the pharmacist with the Familiarize the pharmacist with the activities that occur during a Code Blueactivities that occur during a Code Blue

Identify the procedures followed during a Identify the procedures followed during a Code BlueCode Blue

Delineate the role of the pharmacist as a Delineate the role of the pharmacist as a team member during Code Blueteam member during Code Blue

Evaluate appropriate conduct during Code Evaluate appropriate conduct during Code Blue eventsBlue events

Why Should Pharmacists Why Should Pharmacists Participate in Code Blue?Participate in Code Blue?

Use of medications is inherent Use of medications is inherent Increases likelihood of safe and correct prep Increases likelihood of safe and correct prep

and administrationand administrationPreparation of IV medication falls under Preparation of IV medication falls under

purview and expertise of pharmacistspurview and expertise of pharmacistsDynamic and highly interactive part of Dynamic and highly interactive part of

optimal pharmaceutical careoptimal pharmaceutical care

Crash Cart LocationsCrash Cart Locations

Always know location of crash cart on your Always know location of crash cart on your unit and in the trauma roomsunit and in the trauma rooms

Replacement medication trays are kept in Replacement medication trays are kept in both ICU and Main pharmacyboth ICU and Main pharmacyNew trays are needed post-code when cart is New trays are needed post-code when cart is

cleaned and meds and instruments replacedcleaned and meds and instruments replaced

CHOA ECH Crash CartCHOA ECH Crash CartCart RecordsDefibrillatorMed Labels

Lock Device

Airway and Respiratory Equipment

Oxygen Canister

ECH Crash Cart ComponentsECH Crash Cart Components

TwinPaksNeedles

Tape

Small Syringes

Large Syringes

ScissorsPens

Medication Tray

Nursing Supplies and Equipment

CHOA ECH Code BagCHOA ECH Code Bag

Flushes and Labels

Medications and Syringes

Drug Info Calculator

ECH Code Bag ComponentsECH Code Bag Components

Electrolytes Mannitol

Hi Dose EPIAntibiotics

Flushes and LabelsFluid Bags

Premix Bags

Syringes

Writing PenAlcohol SwabsDispensing Pin

Spikes

TwinPaksNeedlesFilters

Small Vial Meds

Large Vial Meds

Heparins

Attending a Code BlueAttending a Code Blue

NotificationNotificationOverhead PA systemOverhead PA systemPhone call to pharmacy Phone call to pharmacy

ALWAYSALWAYS take the Code Bag! take the Code Bag! Reach site of codeReach site of code

Take stairs when possible, use fastest routeTake stairs when possible, use fastest routeEnter room / area and immediately identify Enter room / area and immediately identify

yourself to staff already in attendanceyourself to staff already in attendance

Pharmacist ProceduresPharmacist Procedures

Ask for patient’s code sheetAsk for patient’s code sheetPlace where it can be readily viewedPlace where it can be readily viewed

Open code bag so supplies are accessibleOpen code bag so supplies are accessibleOpen med tray in crash cart Open med tray in crash cart Notify individuals using crash cart that you Notify individuals using crash cart that you

will handle medicationswill handle medicationsAsk for assistance if overwhelmedAsk for assistance if overwhelmed

Pharmacist ProceduresPharmacist Procedures

Try to gather synopsis of what happenedTry to gather synopsis of what happenedPatient’s age/ historyPatient’s age/ historyEvents leading up to codeEvents leading up to codeWeight and allergiesWeight and allergies

Identify physician running codeIdentify physician running code Identify code recorderIdentify code recorder

Pharmacist ProceduresPharmacist Procedures

Stand by tray and code bagStand by tray and code bagBe sure to stay in sight and earshot of MD Be sure to stay in sight and earshot of MD

running the coderunning the codeTry to be in view of ECG monitor if possibleTry to be in view of ECG monitor if possible

Syringe PreparationSyringe Preparation

When you arrive, prepare epinephrine When you arrive, prepare epinephrine syringe and label immediatelysyringe and label immediately

Unwrap and/or draw up several NS Unwrap and/or draw up several NS flushesflushes

Use the most appropriate syringe size for Use the most appropriate syringe size for dose based on code sheetdose based on code sheet

Syringe PreparationSyringe Preparation

CHOA is a needle-less healthcare systemCHOA is a needle-less healthcare systemYou may use needles to draw up meds if You may use needles to draw up meds if

necessarynecessaryALWAYSALWAYS replace needles with blunt tip replace needles with blunt tip

cannulas before handing of to RN or MDcannulas before handing of to RN or MDUse Twinpaks (needle and cannula device)Use Twinpaks (needle and cannula device)Use blunt cannulas on larger vialsUse blunt cannulas on larger vialsUse syringe connectors if easierUse syringe connectors if easier

Use of TwinPak DeviceUse of TwinPak Device

Pharmacist ProceduresPharmacist Procedures

Obtain IV meds, solutions, syringes, and Obtain IV meds, solutions, syringes, and needles from bag / cart when requestedneedles from bag / cart when requested

Stay focused and listen for requestsStay focused and listen for requestsMay repeat back if uncertain you heard clearlyMay repeat back if uncertain you heard clearly

Try to think one step ahead Try to think one step ahead Prepare additional doses of meds if Prepare additional doses of meds if

necessarynecessary

Dispensing MedicationsDispensing Medications

Draw up requested meds, assemble Draw up requested meds, assemble syringes, exchange needles if necessarysyringes, exchange needles if necessary

Label meds with appropriate stickers Label meds with appropriate stickers immediatelyimmediately

Step to bedside once med is readyStep to bedside once med is readyLoudlyLoudly read name and dose of medication as read name and dose of medication as

you hand to administering RN or MDyou hand to administering RN or MDEnsures correct med is being dispensedEnsures correct med is being dispensedDouble-check that correct med is administeredDouble-check that correct med is administered

Dispensing MedicationsDispensing Medications

Return to stand by medication trayReturn to stand by medication trayRecord meds and time administered if Record meds and time administered if

possiblepossibleMake sure recorder has correct records at the Make sure recorder has correct records at the

end of the codeend of the codeDraw up another syringe of medication just Draw up another syringe of medication just

used if appropriateused if appropriate

Helpful HintsHelpful Hints

Code sheets spell out EXACT amounts of Code sheets spell out EXACT amounts of medications neededmedications neededPreparation instructions and remindersPreparation instructions and reminders

Keep track of what you’ve usedKeep track of what you’ve usedMD may ask how many doses have already MD may ask how many doses have already

been givenbeen givenWatch timing between doses of epi (3-5 mins)Watch timing between doses of epi (3-5 mins)Recorder should corroborate counts of meds Recorder should corroborate counts of meds

and timing for recordsand timing for records

Helpful HintsHelpful Hints

Wearing gloves in a Code Blue situation is not Wearing gloves in a Code Blue situation is not mandatory, but be careful!mandatory, but be careful! Be aware that you could be exposed to blood or Be aware that you could be exposed to blood or

bodily fluidsbodily fluids Know where to find gloves and keep some nearby in Know where to find gloves and keep some nearby in

case necessarycase necessary

If you use needles or other sharps:If you use needles or other sharps: Re-cap used needles and sharps, place in safe spot Re-cap used needles and sharps, place in safe spot

out of your way to prevent accidental sticks or injuriesout of your way to prevent accidental sticks or injuries Dispose properly at the end of the code Dispose properly at the end of the code

Professional ConductProfessional Conduct

Always remain focused on MD running the Always remain focused on MD running the code, listen for requestscode, listen for requests

Watch and be aware of events going on Watch and be aware of events going on around youaround youBe courteous to others using cartBe courteous to others using cart

Professional ConductProfessional Conduct

NEVERNEVER leave a code that is in progress! leave a code that is in progress! If additional supplies or help are needed If additional supplies or help are needed

there are always extra bystanders:there are always extra bystanders:Send extra RN’s to Pyxis Send extra RN’s to Pyxis Have someone call pharmacy for back-up Have someone call pharmacy for back-up Send someone to tube to retrieve medsSend someone to tube to retrieve medsSend someone to pharmacy to retrieve medsSend someone to pharmacy to retrieve meds

Professional ConductProfessional Conduct

End of CodeEnd of CodeAlways ask permission to leaveAlways ask permission to leaveMake sure all medication needs are completeMake sure all medication needs are completeClean up your areaClean up your area

Dispose of trashDispose of trashSharps to appropriate containerSharps to appropriate container

ConclusionConclusion

Remember to take a deep breath and Remember to take a deep breath and pause to think when necessarypause to think when necessaryAlways remain calm and in controlAlways remain calm and in control

Each code you attend will be differentEach code you attend will be differentParticipation becomes easier with each Participation becomes easier with each

time you attendtime you attendYou are an important asset to a team that You are an important asset to a team that

may save a child’s life!!! may save a child’s life!!!