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

Airway and Respiratory Equipment 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

Medications and Syringes CHOA ECH Code Bag Medications and Syringes Drug Info Calculator Flushes and Labels

ECH Code Bag Components Flushes and Labels Writing Pen Alcohol Swabs Dispensing Pin Spikes Fluid Bags Premix Bags Hi Dose EPI Antibiotics Electrolytes Mannitol Large Vial Meds Small Vial Meds TwinPaks Needles Filters Heparins Syringes

Attending a Code Blue Notification ALWAYS take the Code Bag! 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!!!