Managing a code blue as a nurse includes activating the code, sharing clinical information with the team, performing chest compressions, monitoring, and evaluating the code blue process. A code blue is activated whenever a patient or someone is found unconscious, not breathing or without a pulse. Nurses are responsible for identifying sudden changes in the patient’s status. Thus, the code blue team often depends on the nurse’s critical thinking to support the patient and to implement the treatment plan.
What Is A Code Blue?
It is an emergency event that requires immediate cardiopulmonary resuscitation.
Who Can Activate A Code Blue?
Any healthcare staff who receives training about signs and symptoms of clinical emergencies can activate the code blue.
Is Code Blue Serious?
Yes! code blue is very serious because it is a life-threatening medical condition that requires rapid interventions. If help does not arrive on time, the person can die. Choking, heart attack, acute trauma are all conditions that often require immediate treatment.
When Should You Call A Code Blue
You should call a code blue whenever there is an obvious life-threatening situation. You must call a code blue if someone stops breathing, actively choking, profusely bleeding, having a seizure, etc.
Code Blue Team Management
The healthcare organizations establish policies and standards per the American Heart Association – AHA guidelines. The instructions from the code blue policy should include the following:
When to activate a code blue
Who can activate a code blue
What number to call or what button to push or to pull
What information to share with the operator
Who will respond to the code blue event
The time frame for the team to arrive – Response time
Who can lead the code blue – Any Medical Provider can lead the team
The role of each team member
Management of the code cart – emergency supplies inventory
Anesthesiologist/ Certified Nurse Anesthetist- Team leader and airway management.
Respiratory Therapist- Supports the airway and administers rescue medicine.
Pharmacist – Manages and prepares emergency medications
Critical Care/ Code Nurse – Supports the team and administers emergency medications.
Staff Nurse – Provides clinical data to the team
Nursing Assistant – Performs chest compressions and acts as relief and runner.
Nurse Supervisor- Oversees the process and manages patient transfers.
Security – Ensures the physical environment is safe.
Chaplain – Provides spiritual support to all.
Responsibilities When Managing A Code Blue As A Nurse
The nurses play multiple roles during a code blue because they often spend more time with the patients. Thus, they play the role of staff nurse, charge nurse, nurse coordinator or nurse supervisor. The nurses also assist with the management of the code and facilitate bed placement during a code blue.
The charge nurse: That nurse is responsible for managing the unit during the code blue and for supporting the rest of the nursing staff. Besides, the charge nurse coordinates bed placement to a higher level of care during a code blue. Lastly, the charge nurse often delegates a nursing staff to be a runner during the code blue.
The nurse coordinator or the nurse supervisor: In most facilities, that nurse is responsible for documenting the time of the event, the conditions that led to the event, the medical interventions and the patient outcomes following the code. The nurse supervisor also manages emergency requests and patient transfers. Thus, the nurse completes multiple tasks during a code blue.
The code blue nurse: This is a nurse with advanced clinical skills who responds to the code blue immediately. The code blue nurse can administer emergency medications such as Atropine, Adenosine, Epinephrine and more. Therefore, the nurse’s responsibilities during a code blue vary based on a specific role.
Provide Clinical Information And Monitor The Code Blue Process
The staff nurse is the nurse that provides direct care to the patient, and he or she knows the patient history. That nurse will guide the team with information during the code. It is important for that nurse to remain in the room or on-site during the code blue. Thus, the staff nurse is a key team member during a code blue.
The staff nurse can also access the patient’s medical records during the code blue. Furthermore, the nurse should inform the team about the most recent treatments. In addition, it is important to disclose the current medication list and the last medication that the patient received. Furthermore, the nurse should report the most recent vital signs and other symptoms to the code blue team.
The team leader might also like to know the last time the patient ate for intubation and imaging purposes. The direct care nurse should be able to share critical clinical information about the patient. For example, the nurse can share laboratory values and other test results with the team. The staff nurse can also delegate certain tasks to the runner during the code blue.
The patient’s nurse is also responsible for monitoring the code blue process and for documenting the timeline of events and interventions after the code blue. In some instances, the patient’s nurse provides chest compressions until relief arrives. It is crucial to designate a specific staff member to perform chest compressions during a code blue to prevent staff fatigue.
Evaluate The Process When Managing A Code Blue As A Nurse
Following a code blue, the nurse should ensure the completion of the code blue event log. The log is an event timeline with the exact time and descriptions of every intervention during the code blue. Thus, the nurse’s responsibilities during a code blue are to make sure that the team complies with the guidelines. Per the AHA recommendations, the team leader must evaluate the patients for the H & Ts every two minutes.
The code blue log should capture the start of the code until the end of the event. Thus, the nurses or a designee should record every treatment, medication, and intervention on the code blue log. In most healthcare facilities, the log goes in the patient’s chart at the end of the code. If a patient is on isolation, the nurses must follow their organizations’ infection control instructions. Lastly, the purpose of the log is for the organization’s quality improvement team to review.
The Quality team will review the log for compliance with the process and will identify gaps in the system. The team will also identify the root causes of process failure or deviation and will make appropriate recommendations for improvement. A good healthcare institution will promote compliance with the code blue process.
The Nurse should follow his or her facility’s guidelines regarding appropriate precautions when a patient is at risk for contaminating staff and other patients. Please follow standard/universal precautions for all patients. Thus, the nurse should perform hand hygiene before and after patient care and should wear gloves when necessary.
In addition to standard protocol, the nurse will wear disposable masks and gowns for all patients on droplet isolation. Thus, the patient with an active upper respiratory infection like the flu will necessitate droplet precaution. for all patients with contact isolation- transmission only via contact with the patient, the nurse will wear disposable gowns and gloves during the code blue.
The nurse’s responsibilities during a code are to maintain appropriate precautions. Besides, the nurse will wear a special mask (N-95) for all patients with active Tuberculosis, Shingles and other airborne contagious diseases. Lastly, the nurse should follow the Infection Control department’s guidelines for the management of patients with infectious diseases during a code blue.
Daily Check OF The Code Cart Is One Of The Nurse’s Tasks.
Code Cart Functionality
Airway & emergency supplies
Intravenous Fluid and tubing
Defibrillator & Pads
Needles catheters ( peripheral, central and intraosseous)
Suction machine and all other emergency supplies
During a code blue event, the nurses play multiple roles and able to assist the team with different tasks. The nurses assume the responsibilities of charge nurse, code blue nurse, nurse coordinator or supervisor, and staff nurse. Each position is different and enables the nurse to perform at his or her highest potential. The staff nurse will communicate with the receiving nurse during the patient’s transfer.
During a code blue, the nurse also shares clinical information with the team and monitors the patient’s safety to promote the best result. Besides, the nurse coordinates the patient care management during the code blue and facilitates bed placement. Lastly, the team leader relies on the nurse to share clinical information with team members during the event. There is no reason to panic during a code because the team will support the nurses on duty. Please visit nursesophieconsulting to explore nursing services and other related articles.
Nurse Sophie has been a registered nurse for over a decade. I have a Master's degree in nursing, and my clinical experiences include staff nurse, clinical nurse supervisor, nurse manager, and most recently, nurse consultant in Patient Safety and legal nursing. I was always passionate about system operations and practice standards.
I have completed over 2000 hours of medical chart reviews. I am an expert in clinical investigations, and I also develop event timelines. I can assist the legal team with the Discovery process: Deposition, Interrogatories questionnaire, event timelines, locate expert witnesses, and more. I provide and formulate clinical opinions based on the investigative summary.
I also provide nurse coaching services to nurses who experience burnout and looking for a career transition. I have been there! Done that! I was overwhelmed when I as a bedside nurse and wanted to quit nursing until I changed my mindset and faced my fear of the unknown. After multiple failures, I successfully transitioned out of the direct care settings.
It was the best decision that I have ever made. Please send me a request to receive 1:1 career coaching from Nurse Sophie.
Nurse Sophie, MSN, RN, LNC
Legal Nurse Consultant
Patient Safety Specialist
Email: [email protected]