General Patient Care Policy and Procedure Statement s1

MENDOCINO COAST DISTRICT HOSPITAL GENERAL PATIENT CARE POLICY AND PROCEDURE STATEMENT

NUMBER: 205.1130 PAGE: 1 OF 4

TITLE: CODE BLUE – Cardio Pulmonary Resuscitation

PURPOSE: To give direction to staff for initiating and performing resuscitative procedures.

POLICY: There shall be maximum resuscitation efforts in all cases of cardio pulmonary arrest unless there are specific written orders to the contrary. PROCEDURE: CODE BLUE ACTIVATION 1. First Rescuer a. Determine unresponsiveness. b. Call out for "help". c. Activate the Code Blue button if available. Overhead by dialing 8-5-5-0, announcing Code Blue and the location three times in succession in a loud clear voice. 2. There are consoles at PBX and Station II that are connected to the Code Blue response system. When a Code Blue button is activated, the location is displayed on all three consoles. If “Code Blue” has not been announced overhead, anyone who sees this display will page overhead by dialing 8-5-5-0 and announce the location three times in succession in a loud clear voice. 3. Bed is placed in the flat position, and patient airway is opened via head tilt/chin lift maneuver (or jaw thrust/chin lift if cervical neck injury is suspected). If breathing is absent, rescuer will administer two full breaths using Ambu-bag or other available breathing adjunct. Patient breathing will be supported via Ambu-bag and high flow 100% oxygen attached as soon as possible. Pulse check is initiated immediately after rescue breaths. 4. If no carotid pulse is found in adults or children, or brachial pulse is less than 60 found in an infant, CPR will be initiated via American Heart Association Standards. (Headboard from bed or CPR backboard will be placed under all patients before CPR is started.) 5. Adult: Compression to Ventilation Ratio: 30:2 Infant: C/V Ratio: One Rescuer = 30:2; Two Rescuer = 15:2. CODE TEAM 1. Each member of the code team will keep and follow the American Heart Association guidelines. 2. Code Team Roles a. Ventilator: Responsible for maintaining patency of airway and providing ventilatory support including but not limited to inserting an oral airway, endo or orotracheal suctioning, monitoring endotracheal tube placement using CO2 MENDOCINO COAST DISTRICT HOSPITAL GENERAL PATIENT CARE POLICY AND PROCEDURE STATEMENT

detector and by auscultating breath sounds. This should be assigned to a licensed employee (RN or RT). (RT is Monday thru Friday day shift.) i. If an advanced airway is appropriate (i.e., intubation), this should be performed and supervised by a qualified practitioner. ii. Rescue breaths for CPR with advanced airway is one (1) breath every 6 – 8 seconds. b. Compressor: Performs chest compressions according to AHA standards. This can be assigned to non-licensed personnel (i.e. CNA). Individuals performing compressions should be rotated every two (2) minutes. c. CCU Nurse: Supervises the code according to ACLS standard algorithm protocols until the physician arrives. The CCU nurse is responsible for the monitor/defibrillator, identification of rhythms, administration of medications and fluid resuscitation therapy including fluid warming. If the CCU nurse needs to be temporarily relieved of his/her assignment to attend the Code, an RN from Med/Surg, who has had CCU experience and/or will be supervised by the remaining CCU nurse, will be designated as CCU relief nurse. If there is no one qualified on Med/Surg to assume this role, or if there is only one RN in CCU, the Nursing Supervisor or the Department’s Nurse Manager will manage the code until the physician arrives. The CCU nurse is also responsible for bringing the crash cart to the Code site. d. Recorder: Documents the code on the CPR Worksheet (appended). The recorder takes an active part by eliciting as much information as possible during the code. Recorder is also responsible for I & O recording. This can be assigned to either licensed or unlicensed personnel, including Unit Coordinators. If there is not an appropriate employee to designate as recorder, the Nursing Supervisor will assume this duty.

3. Physician: The arrest is managed by one physician. The first physician or CRNA to respond to the code (ED, Hospitalist, Anesthesia, Surgeon) will manage the Code in the absence of the patient's attending physician. If more than one physician responds, the Nursing Supervisor or CCU nurse will ask that the leader be identified. The Nursing Supervisor will also ensure that the attending physician is notified as soon as possible. 4. Nursing Supervisor: The Nursing Supervisor will monitor the Code, control traffic, and be a liaison for the patient's family. He/she will ensure that documentation of the Code is complete and accurate and that the Code Critique and QR form are done. a. When coming on duty, checks to be sure team members are present, and have their assignment. Immediately assigns replacements for any team member not present. b. Upon arrival at Code site, determines if patient is in respiratory arrest, cardiac arrest, or both. c. Checks to see that all team members are present and functioning in their role. d. Confirms that medical help is on the way. e. Summons anesthesia or respiratory therapy (if no response to Code). MENDOCINO COAST DISTRICT HOSPITAL GENERAL PATIENT CARE POLICY AND PROCEDURE STATEMENT

f. Checks to see that effective CPR is being carried out. g. Sets up IV route for administration of drugs if one is not already done. h. Confirms that the Recorder is documenting all relevant data; if necessary, reminds other team members to relay information to the recorder. i. Sees that someone informs the patient's family of the situation and that the family remains in the hospital. j. All deaths are reported to the California Transplant Donor Network at 1-800- 553-6667. It is the responsibility of the primary nurse to ensure the death is reported and the report is documented in the patient’s chart. k. Makes sure that the CPR worksheet is attached to the patient's chart and copy of medications given to Pharmacy. l. Makes certain that attending physician is notified as soon as possible. o Checks to see that Crash Cart has been completely re-stocked and sealed, assists as needed. (The RN who was responsible for the patient at the time of the Code is responsible for re-stocking, checking, and sealing the Crash Cart and if unable to do this due to patient care demands, he/she will notify Nursing Supervisor) 5. Crash Carts: Crash Carts in Med/Surg, ED, CCU, OB, Surgery, Outpatient Services, and Cardiology are checked and stocked according to department protocols.

6. Trauma Code: Additional information appended.

7. Neonatal Resuscitation: See Code Apgar Policy.

8. Codes Occurring Outside the Main Hospital Building: a. MRI/CT Trailer: The MRI/CT Technologist will activate the Code Blue button and overhead page by dialing: 8-5-5-0, announcing Code Blue and the location three times in succession in a loud clear voice. A designated MRI emergency responder from Diagnostic Imaging will immediately go out to the MRI trailer to assist. CPR will be instituted by the technologist until the Code Team arrives. The patient will be transported via the MRI gurney to the elevator on the trailer. At that point, the team will continue CPR and transport the patient to the Emergency Department for further treatment. A barrier device for ventilating patient will be kept in the trailer. b. North Coast Family Health Center: Staff will call “9-1-1" to report the emergency then CPR will be instituted until the Ambulance arrives. A barrier device for ventilating patient will be kept in both areas. c. Pre-Hospital: The Emergency Medical Technicians provide Advanced Life Support per Coastal Valleys EMS Agency protocols.

CODE BLUE OUTCOMES The CCU nurse or Nursing Supervisor will complete a Code Blue Critique (Appendix A). Appropriate data is collected relating to the process and outcomes of resuscitation. There is ongoing review of outcomes relating to resuscitation in aggregate to identify opportunities for improvement of resuscitation efforts. MENDOCINO COAST DISTRICT HOSPITAL GENERAL PATIENT CARE POLICY AND PROCEDURE STATEMENT

Attachments: A: CPR Rubric

New: Revised: 04/09

Approval Signatures:

______Nurse Manager Date

______Chief Clinical Officer Date

______Medical Chief of Staff Date

______Chief Executive Officer Date

______President, Board of Directors Date