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Hospital “Code Blue”

Despite even the best standards for rounding and clinical care, the unexpected happens in hospitals. It’s the nature of being human. “Code Blue” is hospital shorthand for a life-threatening medical emergency in most health systems and clinics. And in many of those cases, that Code is most associated with cardiopulmonary arrest.

Clinician administering CPR during Code Blue.

According to the American Heart Association, approximately 292,000 U.S. adults suffer in-hospital cardiac arrest each year.1 That’s a scary number, and when a cardiac event occurs, time is of the essence.

Fortunately, almost all health providers have a Code Blue response team, and they have the skilled expertise to mitigate a cardiac event. Anywhere from 4 to 15 team members will respond, depending on a hospital’s standards and guidelines, and each team member has their specific role during the emergency. Typically, there may be a time lag of 3-5 minutes between Nurse Call Code activation and response team arrival at the patient’s bedside. Roles include handling the patient’s airway, checking pulse, operating the defibrillator, administering meds, and other crucial tasks. The last step is making a record of the entire event for the patient’s Electronic Health Record (EHR).

Code Blue Response Team in action for HCI Code Blue Response App

Documenting response with HCI’s Code Blue app

A vital member of the Code Blue response team is the Clinical Supervisor or Recorder Nurse. It’s their role to document every aspect of the Code event. When the response team arrives at the patient room, they identify themselves and announce their role. Typically they’ll say “I’ll take the airway” or “I’ll document.” It’s the Recording Nurse or Clinical Supervisor that will use the HCI Code Blue app documentation features available through MediaCare.

The Recorder Nurse

Due to the the sudden nature of a Cardiac emergency call, the designated team drops what they’re doing and rushes to the scene. Arriving on scene, they’re likely experiencing some stress. That’s understandable – it’s a tense time, but these professionals know their jobs. Arriving in the room, the Recorder Nurse grabs a clipboard, or whatever material is on hand to write down each step of the Code response, like each time there’s a pulse check; administration of Epinephrine, defibrillator activation, and so on.

Emergency team responding to patient event.

There’s got to be a better way

Can you guess what the most common thing is for the Recorder Nurse to use in documenting the call? Their hand or arm! That’s right – it’s common for Recorder Nurses to document Code Blue calls on their hands (or their scrubs) with an ink pen or Sharpie©.

Nurses often write vital Code Blue data on their hands.
It’s not uncommon for Code Blue event documentation to be recorded in ink on scrubs or hands.

Documentation challenges

Think about the opportunities to miss or forget a critical point for documenting the Code event on hands or clothing. What’s more, time spent on transferring notes and reading the handwritten information may not create a complete picture of the Code. And what if it’s necessary to transfer the patient to another unit or intensive care? Those records aren’t immediately available. It’s only at the end of the event they can transfer the notes and the team information on to paper for scanning into a patient’s EHR. Clearly, that’s a questionable process at best, and may compromise patient safety.

Recorder Nurse using clipboard to document cardiac event.

Help is here: Digital event recording

To make the record more efficient and accurate, HCI offers the Code Blue Response module. Upon entering the room, the Recorder Nurse or any member of the response team simply taps the “Start” icon on the Patient Whiteboard. The Code event is automatically recorded, and automatically written back to the EHR at the end of the Code.

In addition, the “Start” icon immediately initiates a CPR Metronome so anyone giving hands-on CPR can use the tones of the Metronome to keep even, consistent chest compressions with the correct timing. Tapping “Stop” turns off the Metronome audio, but the event detail is still captured. When the Code alerts, the patient’s most recent Telemetry and Lab results display on the Patient Whiteboard, so the response team has important patient information as they work.

HCI Code Blue Telemetry example.
Telemetry displays automatically when a Code Blue is called.
HCI’s CPR Metronome
HCI CPR Metronome Digital Whiteboard Header
The Start and Stop icons for the Patient Whiteboard Code Blue module

The Code Blue app includes a progressive “elapsed time” bar that dynamically displays the elapsed time of the event. What’s more, HCI has built in PULSE, EPI and SHOCK buttons that automatically document those Code tasks. The Recorder Nurse simply touches the appropriate button and the data is recorded. Plus, HCI returns any DNR or other critical information up front, so the team is prepped for the patient’s wishes. The Hall Whiteboard and the Unit Whiteboard also display a Code Blue alert status.

HCI Code Blue Task confirmations are automatically written back to the EHR.
The HCI Code Blue data: EPI, Shock & Pulse events are date and timestamped, then automatically written back to the patient’s EHR.

Additional activity markers

The Code Blue module supports nine additional activity markers we can configure for your Code Blue response needs, plus a freeform activity marker that you define during your implementation workflow analysis. For example, we can configure the app to display Joules (for Shock), Dose, and more.

Learn how HCI makes your Code Blue response more efficient and accurate across our line of digital whiteboards.

Learn more about CPR and ECC Guidelines from the American Heart Association: https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines

1 https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000950?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org#d1e676