CHOA at Egleston Code Blue Procedures
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Transcript CHOA at Egleston Code Blue Procedures
CHOA at Egleston
Code Blue Procedures
Updated November 2008 by
Leah Hatfield PharmD, BCPS
Objectives
Familiarize the pharmacist with the
activities that occur during a Code Blue
Identify the procedures followed during a
Code Blue
Delineate the role of the pharmacist as a
team member during Code Blue
Evaluate appropriate conduct during Code
Blue events
Why Should Pharmacists
Participate in Code Blue?
Use of medications is inherent
Increases likelihood of safe and correct prep
and administration
Preparation of IV medication falls under
purview and expertise of pharmacists
Dynamic and highly interactive part of
optimal pharmaceutical care
Crash Cart Locations
Always know location of crash cart on your
unit and in the trauma rooms
Replacement medication trays are kept in
both ICU and Main pharmacy
New trays are needed post-code when cart is
cleaned and meds and instruments replaced
CHOA ECH Crash Cart
Cart Records
Defibrillator
Med Labels
Airway and
Respiratory
Equipment
Oxygen
Canister
Lock Device
ECH Crash Cart Components
TwinPaks
Needles
Tape
Scissors
Pens
Medication Tray
Large Syringes
Small Syringes
Nursing
Supplies and
Equipment
CHOA ECH Code Bag
Medications
and Syringes
Flushes and
Labels
Drug Info
Calculator
ECH Code Bag Components
Writing Pen
Alcohol Swabs
Dispensing Pin
Spikes
Fluid Bags
Premix Bags
Flushes and
Labels
Hi Dose EPI
Antibiotics
Electrolytes
Mannitol
Large Vial Meds
Small Vial Meds
TwinPaks
Needles
Filters
Heparins
Syringes
Attending a Code Blue
Notification
Overhead PA system
Phone call to pharmacy
ALWAYS take the Code Bag!
Reach site of code
Take stairs when possible, use fastest route
Enter room / area and immediately identify
yourself to staff already in attendance
Pharmacist Procedures
Ask for patient’s code sheet
Place where it can be readily viewed
Open code bag so supplies are accessible
Open med tray in crash cart
Notify individuals using crash cart that you
will handle medications
Ask for assistance if overwhelmed
Pharmacist Procedures
Try to gather synopsis of what happened
Patient’s age/ history
Events leading up to code
Weight and allergies
Identify physician running code
Identify code recorder
Pharmacist Procedures
Stand by tray and code bag
Be sure to stay in sight and earshot of MD
running the code
Try to be in view of ECG monitor if possible
Syringe Preparation
When you arrive, prepare epinephrine
syringe and label immediately
Unwrap and/or draw up several NS
flushes
Use the most appropriate syringe size for
dose based on code sheet
Syringe Preparation
CHOA is a needle-less healthcare system
You may use needles to draw up meds if
necessary
ALWAYS replace needles with blunt tip
cannulas before handing of to RN or MD
Use
Twinpaks (needle and cannula device)
Use blunt cannulas on larger vials
Use syringe connectors if easier
Use of TwinPak Device
Pharmacist Procedures
Obtain IV meds, solutions, syringes, and
needles from bag / cart when requested
Stay focused and listen for requests
May repeat back if uncertain you heard clearly
Try to think one step ahead
Prepare additional doses of meds if
necessary
Dispensing Medications
Draw up requested meds, assemble
syringes, exchange needles if necessary
Label meds with appropriate stickers
immediately
Step to bedside once med is ready
Loudly read name and dose of medication as
you hand to administering RN or MD
Ensures
correct med is being dispensed
Double-check that correct med is administered
Dispensing Medications
Return to stand by medication tray
Record meds and time administered if
possible
Make sure recorder has correct records at the
end of the code
Draw up another syringe of medication just
used if appropriate
Helpful Hints
Code sheets spell out EXACT amounts of
medications needed
Preparation instructions and reminders
Keep track of what you’ve used
MD may ask how many doses have already
been given
Watch timing between doses of epi (3-5 mins)
Recorder should corroborate counts of meds
and timing for records
Helpful Hints
Wearing gloves in a Code Blue situation is not
mandatory, but be careful!
Be aware that you could be exposed to blood or
bodily fluids
Know where to find gloves and keep some nearby in
case necessary
If you use needles or other sharps:
Re-cap used needles and sharps, place in safe spot
out of your way to prevent accidental sticks or injuries
Dispose properly at the end of the code
Professional Conduct
Always remain focused on MD running the
code, listen for requests
Watch and be aware of events going on
around you
Be courteous to others using cart
Professional Conduct
NEVER leave a code that is in progress!
If additional supplies or help are needed
there are always extra bystanders:
Send extra RN’s to Pyxis
Have someone call pharmacy for back-up
Send someone to tube to retrieve meds
Send someone to pharmacy to retrieve meds
Professional Conduct
End of Code
Always ask permission to leave
Make sure all medication needs are complete
Clean up your area
Dispose
of trash
Sharps to appropriate container
Conclusion
Remember to take a deep breath and
pause to think when necessary
Always remain calm and in control
Each code you attend will be different
Participation becomes easier with each
time you attend
You are an important asset to a team that
may save a child’s life!!!