Transcript Revised Code Blue Record and Get With the Guidelines

Revised Code Blue Record
and Get With the
Guidelines-Resuscitation
Justin Hamilton, BSN, RN
Aultman Hospital
Critical Care Coordinator
 Completion of this Learning Module is
mandatory for RN’s and LPN’s within Aultman
Hospital who currently utilize the Code Blue
Record to document a Code Blue event.
 Read the information contained in this learning
module.
 Read and sign the Accountability Form entitled:
Revised Code Blue Record and Get With the
Guidelines-Resuscitation
 Completion Deadline: June 15, 2012
Information and Instructions

Objectives: At the end of this learning
module, the nurse should be able to:
◦ Identify the documentation revisions made to
the Code Blue Record.
◦ Discuss the intent American Heart Association
(AHA) Get With the Guidelines-Resuscitation
(GWTG-R) Program.
Objectives
AULTMAN CODE BLUE RECORD
PATIENT LABEL
Onset Information:
Initial Breathing:
Initial Ventilation:
Circulation
Intubation:
Confirmation:
□ Spontaneous □ Agonal
□ Apnea
□ Ventilator
Time of first assisted ventilation: __________
□ Bag-Valve-Mask
□ Endotracheal tube
□ Tracheostomy
□ Other: __________________
□ NO □ YES: Time: _________ Size: ________
By Whom: _____________________
□ Ausculatation
□ End CO2
□ Other: _____________________________________
1st PULSELESS rhythm: __________ time: ______ Compressions: □ None □ Manual AED Applied: □ NO □ YES: time: ______
External Pacemaker:
□ NO □ YES: time: _________
settings: ____ ma _____ rate _____mode
IV Access Type: ___ peripheral: □ new □ prior
location(s):______________ If new line, inserted by: _____________________
Responders
Airway/resps
Date: __________ Time: __________ Location: ______________ Code Status Prior:__________
Hospital-wide resuscitation response activate: □ YES □ NO
Witnessed: □ YES □ NO
Conscious at onset?
□ YES □ NO
Pulse at onset: □ NONE □ WEAK □ PRESENT
Weight: ________ Height: _____________
EVENT TYPE: □ Respiratory Arrest □ Respiratory leading to Cardiopulmonary Arrest □ Cardiac Arrest
Monitoring at Onset:
ECG
Pulse Oximeter
Apnea
Charge Physician: ___________________________ Physician: ____________________ Physician: ________________________ Respiratory-1: ________________________
___ central line: □ new
□ prior
location(s):_____________
If new line, inserted by: _____________________
Respiratory-2: ______________________ RN Code Coordinator: _______________________ Medication/CV RN: ________________________ Supervisor: _____________________
Floor Nurse: _____________________ Recorder: ____________________ Recorder sign: ______________________ Charge Physician sign: ____________________________
Outcome
***Patient Physician notified: Dr. ______________________ notified by: __________________________ time: _____________
Time Code ended: ________ Reason ended: □ Return of Circulation □ Efforts Terminated □ Family Request Status: □ SURVIVED □ EXPIRED
Family present for code: □ YES □ NO if no: Family member notified: __________________ by: __________________ Time: _________
Destination: ___________________
Candidate for Hypothermia Protocol? □ YES
□ NO
BOLUS Emergency Medications:
OTHER BOLUS MEDICATIONS and INFUSIONS:
EPINEPHRINE
ATROPINE
AMIODARONE
BICARB
Time: Dose/Route:
______ _________
Time: Dose/Route:
______ ________
Time:
Dose/Route:
______ ________
Time:
Dose/Route:
______ ________
______ _________
______ ________
______
______
______ _________
______ ________
______ _________
______ ________
______ _________
______ ________
________
_______
________________
_________
_______
________________
_________
_______
%SAT
BP
IVF:
_________
_
VITAL SIGNS
OTHER
*KEY: Pulse: C=compressions resps: B=bagged
Mg/min
_______
________
Amiodarone
_________
______
Mcg/kg/min
________________
______ ________
Dopamine
______ _________
______ _________
Mcg/min
_______
Levophed
_______
_________
(joules)
_________
________________
Defribrillator
________________
Rhythm
LIDOCAINE
______ ________
resps*
ROUTE:
_________
Time:
Dose/Route:
______ _________
______ _________
Pulse*
TIME:
________________
VASOPRESSIN
Time:
Dose/Route:
______ ________
TIME
DRUG/DOSE:
________
CODE EVENTS
(labs, line insertion, etc.)
Precode
Form 399 (93400) R: 12/10
White: CHART
Yellow: Critical Care Coordinator
PAGE _____ of ______
PROGRESS NOTES
Code Blue Record Revision

Four Additions Under “Onset Information:”
1. Code Status Prior

Blank to be filled in by Recorder


Yes if code was paged overhead
No if code was not paged overhead (ICU situations
where physician is present and able to intubate patient
or physician present and patient previously intubated)
2. Hospital-wide resuscitation response active
3. Height

Blank to be filled in by Recorder

ECG (Telemetry monitor or ICU monitor), Pulse
oximeter, or Apnea, these boxes should be checked if
patient was ordered to have these monitors in use
4. Monitoring at onset:
What was changed on the Code
Blue Record?
AULTMAN CODE BLUE RECORD
Was code
paged
overhead?
Onset Information:
Indicate Code Status
Prior to the Code
Event.
Date: __________ Time: __________ Location: ______________ Code Status Prior:__________
Hospital-wide resuscitation response activate: □ YES □ NO
Fill in the
patient’s height.
Witnessed: □ YES □ NO
Conscious at onset? □ YES □ NO
Pulse at onset: □ NONE □ WEAK □ PRESENT Weight: ________ Height: _____________
EVENT TYPE: □ Respiratory Arrest □ Respiratory leading to Cardiopulmonary Arrest □ Cardiac Arrest
Monitoring at Onset: ECG Pulse Oximeter Apnea
Indicate any monitoring that was
ordered prior to the initiation of the code.
Changes at a glance…

Form 399A will be an addendum sheet
that will be formatted identical to the
bottom box on the present Code Blue
Record.
◦ This page will be utilized to document once the
initial spaces are filled in.
◦ The Recorder then must fill in the “Page_of_”
section at the bottom of all forms.
Code Blue Record Addendum
AULTMAN
CODE BLUE RECORD
PATIENT LABEL
Form 399A (93412) R: 05/12
White Copy: Chart
Form 399A:
Yellow Copy: Critical Care Coordinator
PAGE ___ of ___
IVF: _______
BP
Other
%SAT
Amiodarone
Mg/min
Pulse* Resps*
Dopamine
(Mcg/kg/min
TIME
Levophed
Mcg/min
*KEY: Pulse: C = Compressions Resps: B +Bagged
Defibrillator
(joules)
VITAL SIGNS
Rhythm
VITAL SIGNS
CODE EVENTS
(labs, line insertion, etc.)
PROGESS NOTES
Code Blue Record / Vital Signs

The Code Blue Record was changed in
preparation for the participation of
Aultman Hospital in the American Heart
Association (AHA) Get With the
Guidelines-Resuscitation (GWTG-R)
Program.

The additional sections will allow for more
efficient data entry into the GWTG-R
database by Intensivist team nurses.
Why was the Code Blue Record
Changed?

GWTG-R is a program that allows hospitals to enter
and review arrest events.

The participating hospitals can then make changes to
ensure that they are providing the best possible
outcomes for their patient populations.

Individual hospital data can be compared to other
similar facilities participating in the GWTG-R program.

Participating hospitals will be eligible to receive
Bronze, Silver, and Gold Awards based on the
achievement of set outcomes.
What is GWTG-R?

Following the Code Blue event, the white
copy of the Code Blue Record should be
placed on the patient’s medical record.

The yellow carbon copy of the Code Blue
Record should be detached, placed in an
envelop and sent to Medical Intensive Care or
Justin Hamilton, Critical Care Coordinator
through Interoffice Mail. (CCU nurses: please
note we have these envelopes on our code
carts!!)
What is GWTG-R?
CONTINUED

Hospitals must achieve 85% compliance in the
following four outcomes to be recognized by the
AHA for GWTG-R awards:
1. Time to first chest compressions <= 1 minute in adult
and pediatric patients.
2. Time to first shock <= 2 minutes for VF (Ventricular
Fibrillation)/pulseless VT (Ventricular Tachycardia) first
documented rhythm.
3. Pulseless cardiac events monitored or witnessed at the
time of arrest.
4. Device confirmation of correct endotracheal tube
placement (End Tital CO2 Cap or Capnometry device
supplied with all endotracheal intubation trays
presently on Code Carts).
GWTG-R Outcomes

All information pertaining to GWTG-R
obtained from The American Heart
Association web site:
http://www.heart.org/HEARTORG/HealthcareRes
earch/GetWithTheGuidelines-Resuscitation/GetWith-The-GuidelinesResuscitation_UCM_314496_SubHomePage.jsp
References
For any questions please contact:
Justin Hamilton, BSN, RN
Office Phone: (330) 363-4284
Email: [email protected]
Questions / Contact Information
After you have completely
read and understand
this material, please enter
the Quiz section of Quia
and complete the
Accountability Form for
Revised Code Blue Record and
Get With the GuidelinesResuscitation.
Accountability Form