1. Revision of Hospital Emergency Codes
Stonewall Jackson Memorial Hospital
Chuck Chabanik – Director of Facilities & Safety Officer
Jennifer Barnes, RN – Chief Quality Officer

2. BACKGROUND - How this project began…
70%
Data collection during rounds
Questioning staff about emergency codes
Nurse & New Hires
Sometimes a group effort
Results – not where we
Would like them to be

3. BACKGROUND - How this project began…
Heat of the Moment
Calling the correct code
All the additional information needed

4. BACKGROUND - How this project began…
Missing Child
“CODE AMBER…UM
CODE ADAM…
MALE…
INFANT…
OB”

5. BACKGROUND - How this project began…
I need to call
CODE SILVER ?

6. BACKGROUND - How this project began…
We had a meeting…
Then Chuck went to a meeting…

7. The Region 6/7 Meeting
Proposed to standardize Emergency Codes across Region
Many Healthcare workers are employed in more than 1 facility
Many people who work in healthcare are also first responders
Need to be as transparent as possible
Increased situational awareness

8. The Region 6/7 Meeting
GOAL 1 – Every organization in Region 6/7 to adopt the same codes
GOAL 2 – Be an example to the State for consistent overhead emergency codes
Chuck Chabanik volunteered to work with Maxine Cantis – Environmental Mon General to propose consistent codes to be used within our facilities

9. NOT A NEW CONCEPT
2012 – Joint Commission recommended moving to standardization in their publication, Emergency Management in Health Care: An All Hazards Approach.
Plain Language and Standardization supported by:
US Department of Health & Human Services
US Department of Homeland Security
The National Incident Management System
The Institute of Medicine

10. CURRENT EMERGENCY CODES AT SJMH
OUR CURRENT STATE
CURRENT EMERGENCY CODES AT SJMH
Code YELLOW
General Disaster
Code RED
Fire
Code GRAY
Security Needed
Code ORANGE
Haz Mat Spill (Internal)
Code SILVER
Active Shooter (Internal)
Code BROWN
Bomb Threat
Code AMBER/ADAM
Missing Child (Gender)
Code AMBER/ADAM SENIOR
Missing Adult (Gender)
Code PINK
Missing Infant
Code SEVERE WEATHER
Severe Weather

11. OUR FUTURE STATE
FUTURE EMERGENCY CODES AT SJMH
Activate Emergency Operations
General Disaster
Code RED
Fire
Code GRAY
Security Needed
Code ORANGE
Haz Mat Spill (Internal)
Code AMBER
Missing Child
Code WALKER / ELOPEMENT
Missing Adult
Code PINK
Missing Infant
Code BLACK
Bomb Threat
ACTIVE SHOOTER
Active Shooter
Code Weather
Severe Weather
Items listed in RED are codes that will be changed at SJMH

12. OPPORTUNITY FOR IMPROVEMENT
Review of our ALL Emergency Operations & Codes
Develop Subject Matter Experts
Review Department Level Response Plans
Standardized Template
Reviewed in conjunction with Subject Matter Experts

13. HOW ARE WE GETTING THERE
DMAIC - Our performance improvement model
Using evidenced-based tactics for creating change
Right people at the table
Roles & Responsibilities
Due Dates
Set a ‘GO-LIVE’ DATE
November 15, 2017

14. First Meeting – July 17, 2017 OUR TASK FORCE VOLUN-TOLDS VOLUNTEERS
Safety Officer
Education
Infection Control / Quality
Environmental Services
House Supervisor / Nursing
Surgery Department
Human Resources (Military Police)
Supply Chain (retail background)
Marketing
Administrative Assistant
Chief Nursing Officer
AD HOC Members: Asst. CEO and IT
First Meeting – July 17, 2017

15. OUR PLAN
Using Florida Hospital Association “Overhead Emergency Codes – Hospital Guidelines” as a model
Theirs is 34 pages - ours is 6
Includes Project Background
Evidenced-based support of change
Action Phase – (How we got started)
Implementation Strategy

16. OUR PLAN Developed an Action Plan Divided into 3 PHASES
Implementation (Planning & Education)
Go Live
Post Go Live
Assigned Responsible Parties
Set Due Dates

17. METRICS FOR COMPLETION & SUCCESS
OUR PLAN
Established metrics to measure success at each stage
METRICS FOR COMPLETION & SUCCESS
PLANNING
EDUCATION
GO-LIVE
POST -ACTIVATION
Completion of action items
Departmental Education for each code
Completion of Go-Live Items
Code knowledge during rounding
Completion of Dept. response to existing codes
Success of conducted drills
Completion of Dept. response to NEW codes

18. CLOSING Emergency Management is essential
Involvement of Senior Leadership
Hospitals must be prepared for the unknown
This size of a project cannot be accomplished by one individual
Find your subject matter experts
Data drives change
You cannot manage what you cannot measure

19. QUESTIONS
Chuck Chabanik – Director of Facilities/Safety Officer (304) Jennifer Barnes, RN – Chief Quality Officer (304)