Code Blue/Pink

North York General Hospital

Nursing Orientation

Code Blue/Pink Objectives

• Understand Code Blue/Pink process

• Describe how to activate a Code

• Describe the roles/responsibilities of the team members

• Discuss daily crash cart checks

• Discuss what Code record to document on

What is a Code Blue ?

• An actual and/or impending respiratory and/or cardiac arrest in patients 18 years or older

What is a Code Pink/ Code Pink -

Adolescent?

• An actual and/or impending respiratory and/or cardiac arrest for the Paediatric population:

• Code Pink - Ages 0 to 12 years• Code Pink Adolescent - Ages 13 to 18 years

What is a Code Blue/Pink “Airway

Emergency”?

• Code Blue/Pink team members may initiate an Airway Emergency when the code team is having difficulty establishing an airway.

How to call a Code Blue/Pink “Airway

Emergency”

• Code Blue/Pink team members may request an Airway Emergency by: calling 5555 for Hospital Paging/Locating and state “Airway Emergency” and give the location of the patient , i.e. unit and room number.

Paging/Locating will:• Activate the Airway Emergency procedure• Announce “Airway Emergency” on the overhead paging system and

indicate the unit and room number• Place a STAT call to the Anaesthetist on call and all designated

physicians with special expertise in management of a failed airway

What is a Code Blue/Pink Trauma?

• The Code Blue/Pink team can request a Code Blue/Pink trauma when assistance is required.

– Definition: Trauma emergencies encompasses all care necessary to deal with sudden and potentially life-threatening events involving trauma (c-spine injury, amputation of limbs, fall from significant height, penetrating injury etc.).

– Example: unwitnessed/witnessed fall down the stairs, or fall from significant height inside or outside the hospital.

How to call a Code Blue/Pink Trauma

• Code Blue/Pink team members may initiate a code blue/pink trauma when assistance is required.

• To initiate a Code Blue/Pink Trauma, dial 5555 for Hospital Paging/Locating and State “Code Blue/Pink Trauma and give the location of the patient, i.e. unit and room number.

Paging/Locating will:• Activate the Code Blue/Pink Trauma procedure• Announce “Code Blue/Pink Trauma” on the overhead paging system

and indicate the unit and room number/location• One Emergency physician and Emergency nurse will respond to the

call and bring equipment with them (c-spine collar, backboard)• Place a call to Corporate Risk Manager and notify the Risk Manager

of code blue trauma

Staff Responsibilities

• When a Code is announced overhead the

following occurs:

– Unit Staff, CrCU, ED & Paediatric staff return to

their units

Remember!

• A Code Blue/Pink is considered a “HIGH RISK” procedure

• Code Team members must wear 4 point PPE

Code Blue/Pink Team Members

• Physician (according to specialty area)

• Anesthetist-when available

• CrCU/ED nurse, Paediatric & NICU nurse (or delegate)

• Registered Respiratory Therapist

• ECG/Lab Technician

• Porter

• Chaplain/Social Work-when available

Code Blue: Who Responds

• CrCU staff: Covers the 2nd to 8th floor

• ED staff: responds to main floor (Lobby &

Cafeteria), first floor, sub-level floor, and the

hospital grounds

Code Pink: Who Responds

• NICU staff respond to Code Pinks in all areas

of the hospital

• Paediatric staff respond to Code Pinks in all

areas of the hospital with the exception of

L&D and Mother Baby Unit.

• ED staff: responds to main floor (Lobby &

Cafeteria), first floor, sub-level floor, and the

hospital grounds

Code Pink Adolescent: Who Responds

• The Paediatrician, Paediatric RN, Emergency

Physician, and ED RN respond to all Code Pink

Adolescent codes in the hospital with the

exception of the Paediatric RN only attending

Code Pink Adolescent in ED when required.

How to call a Code from a Specialty

Area

• Hospital Grounds: parking lot, the attendants

call an in-house code and 911, ED staff will

respond simultaneously

• 4000 Leslie Street & Seniors’ Health Center:

dial 9 first & then 911

Adult/Adolescent Crash Cart

Paediatric & Neonatal Crash Carts

Broselow CartNeonatal Cart

The Defibrillator

Lead Placement

The Orange Roll-Adult Carts

Daily Crash Cart Responsibilities!

• Defibrillator

• Oxygen tank

• Suction equipment

• Orange roll/Blue roll

• Red Seal

When to check entire contents of the crash cart?

• Immediately after a code

• Once a month

• If the number on the red tag seal does

not correspond with the number on the

checklist

Restocking Crash Cart

Drugs and equipment used must be replaced immediately

• A replacement drug tray is obtained from pharmacy between the hours of 0800h-1900h Monday to Friday. And between 0800h-1600h on Weekends/Statutory holidays .

• After hours, Portering Services will deliver replacement drug trays on request. The used drug tray will be returned at any time only AFTER receiving the new replacement tray.

• Portering Services will obtain intubation equipment (i.e. Orange Intubation Roll) from the Respiratory Therapy Department.

Initiating A Code

DO NOT PANIC!

STAY CALM!!!

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Initiating a Code

• Push the “code button” in patient’s room if

available

• Dial 5555-state location

• If a second code is called concurrently, it will be

announced as “SECOND CODE Blue/Pink

Responsibilities of the Code Team

In House Physician Lead/Team Leader (or delegate)

• Directs all resuscitative measures

• Decides when to cease resuscitative measures

• May delegate the role of the Team Leader to

the Most Responsible Physician (Primary Care)

• Paediatrician may request ED or Internal

Medicine when necessary

Anesthetist on call/RRT

• Establishes or assists in securing and

maintaining a patent airway

• RRT assists with transfer of patient

CrCU, ED, NICU & Paediatric Nurse

Delegates & Coordinates the following activities:

� C- circulation

�A- airway

� B- breathing

� IV access

� Venipuncture

�Accompanies patient

during transfer

�Medication preparation

and administration

�Documentation

�Defibrillation (certified

RN only)

� Crowd control

� Rhythm monitoring

Primary Nurse/First Responder

• Assesses patient for absence of pulse and breathing

• Calls for help without leaving patient

• Notes time of arrest

• Initiates CPR according to BCLS (C, A, B)

Assess for no more than 10 seconds

DO NOT Delay C “Circulation”

Second Responder

• Initiate Code dial 5555 & press code button (if available)

• Identify location (unit, room, bed)

• Don mask, gloves, gown and goggles

• Bring Crash Cart to scene

• Place the board under the patient

• Relieve First responder to don 4 point PPE

• Assist with chest compressions

1st Responder

2nd Responder

Important step before 1st Responder dons PPE

2nd Responder begins CPR

Charge Nurse/Unit CoordinatorDelegate activities as required

• Documentation • Bring patient’s chart and MAR • Notify most responsible physician • Consult Chaplaincy/Social Worker • Ensure other patients’ safety• Facilitate completion of Cardiac Arrest Record• Ensure Crash Care equipment and drugs are

replenished immediately after the code

Documentation

• Cardiac Arrest Record must be completed for ALL PATIENTS

• A yellow copy to be forwarded to the Unit Administrator for review

• All staff present at the Code must be listed on the Resuscitation Record

• MDs, RRTs & RNs must sign their full name and designation

Code Blue/Pink

•Do Not Forget about the Family•Make sure they are informed and supported during this difficult time

Resuscitation Records

Resuscitation Record

Resuscitation Record

Resuscitation Record

References

• North York General Hospital General Policy

Manual

• Available on the Hospital Website Under

Policies & Procedures

Thank You