The Role of Code Blue Team’s

PERHIMPUNAN DOKTER AHLI EMERGENSI INDONESIA

 Code Blue ???

“Code Blue is a declara.on of or a state of

medical emergency and call for medical
personnel and equipment to a8empt to
resuscitate a pa.ent especially when in
cardiac arrest or respiratory distress or failure”
 Legality

• UU RI No 44 tahun 2009 tentang Rumah sakit

pasal 29 ayat 1 : Pelayanan medis kedaruratan
>> “Hospital Emergency Codes (Kode emergensi
rumah sakit) diperlukan diseluruh rumah sakit
untuk memberikan informasi secara cepat ,
dengan kesalahan interpretasi yang minimal
kepada seluruh staf tentang kegawat
daruratan (airway-‐cardiac arrest) yang sedang
terjadi”
 Permenkes RI No. 1961 /2011
Tentang Keselamatan Pasien Rumah Sak
• Pasal 1, Ayat 1 :
“ Keselamatan pasien rumah sakit adalah suatu s
dimana rumah sakit membuat asuhan pasien lebih
aman yang melipuX asesmen risiko, idenXfikasi da
pengelolaan hal yang berhubungan dengan risiko
pasien, pelaporan dan analisis insiden, kemampuan
belajar dari insiden dan Xndak lanjutnya serta
implementasi solusi untuk meminimalkan Xmbulnya
risiko dan mencegah terjadinya cedera yang
disebabkan oleh kesalahan akibat melaksanakan su
Xndakan atau Xdak mengambil Xndakan yang
seharusnya diambil.”
 AcXvaXon
When Code Blue applies ???
1. When the person is unresponsive and has no
signs of life.
2. The staff believe that the paXent, visitor or staff
member requires urgent medical a^enXon
within 10-‐15 minutes.

(Code blue manual by Royal Brisbane & Woman’s Hospital Health Service District )
 Working Area
• All Hospital area and ward, except :
– Emergency Department
– Intensive care unit
– NICU
– OK

(Akreditasi Rumah Sakit V.2012)

Medical Emergency Team Calling Criteria
All Cardiac and Respiratory Arrests and All CondiXons Listed Below
Acute Changes in: Vital Sign
Airway Threatened
Breathing All respiratory arrests
Respiratory rate < 5
Respiratory rate > 36
CirculaXon All cardiac arrests
Heart rate < 40
Heart rate > 140
Systolic Blood Pressure < 90
Neurology Sudden fall in level of consciousness
( fall in GCS of > 2 point )
Repeated or Prolonged seizure
Other Any paXent who does not fit the criteria above
who you are
Seriously worried about
To call the Medical Emergency Team Phone xxxx and tell the operator
where you are

(Code blue manual by Royal Brisbane & Woman’s Hospital Health Service District )
Structure and Roles of Code Blue Team
• Physician –
– as the CBT leader
– Apply ACLS algorithms
– Ensure good scene and crowd control
• Unit/Ward RN –
– IniXate BLS including applicaXon of the AED
– Assists the code team as needed
– Give informaXon to leader about the paXent
– Facilitates communicaXon with family members
• CriXcal Care/Emergency RN
– FuncXon as team leader unXl the physician arrives
– Manage and monitors defibrilator and rhythm strips
– Apply chest compression (CPR)
– Administer medicaXon
– DocumentaXon record
– Manage the emergency trolley
• Airway Manager –
– Provide basic and advanced airway management :
• Bag Valve Mask venXlaXon
• High flow oxygen
• SucXoning
• intubaXon

Gerganoff 2012; Code arrest/code blue management within CHN FaciliKes : Carondelet Health
Network
Montgomery College Hospital SimulaKon Lab : Code Blue team : Roles and FuncKon, 2011
 Team PosiXon on Scene

CPR
( one or two)
Change every
2 minute
IV Nurse +
Providing safe
defibrilaKon
DocumentaKon

Copied from MontgomeryCollege Hospital SimulaKon Lab : Code Blue team: Roles and FuncKon, 2011
 Team CommunicaXon
• EffecXve communicaXon is CriXcal for team
working in crisis situaXon.
• CommunicaXon ensures that everybody
knows :
– what is going on,
– what needs to be done,
– what is already done.
• REMEMBER : CommunicaXon is important to
the sender and to the receiver
• A message is only communicated if it is both
SENT and RECEIVED
– Meant is not said
– Said is not heard
– Heard is not understood
– Understood is not done
 Step for CommunicaXon
• Closed loop communicaXon
– The leader should give an order or assignment then
confirm that the message was heard.
– Team members confirm that the order or assignment
was heard
– inform the leader when the task is complete.
Example:
Team Leader : “Give 1 mg Epinepherine IV now”
IV Nurse : “1 mg Epinepherine given IV at 9:05”.
• Clear messages –
– All messages should be delivered in a calm and direct
– No yelling or shouXng.
– Speak clearly.
– Team members should quesXon an order if they are
unsure what was said.
• Clear roles and responsibiliXes –
– Every member of the team should know his/her role
and responsibiliXes.
– To avoid in efficiencies, the team leader should clearly
delegate tasks.
– A team member should not accept assignments above
their level or competence or experXse.
• Knowing one’s limitaXons –
– Every member of the team should know his/her
imitaXons and capabiliXes and the team leader should
be aware of them.
– A new skill should not be a^empted during the arrest.
• Knowledge sharing –
– A criXcal component of effecXve team performance is
informaXon sharing.
– The team leader can ask for other suggesXons when
the resuscitaXon efforts seem to be ineffecXve.
• ConstrucXve intervenXon –
– During a code, a team leader or member may
need to intervene if an acXon is about to occur at
an inappropriate Xme.
– The person recording the event may suggest that
epinephrine be given as the next drug because it
has been 5 minutes since the last dose.
– All suggesXons for a different intervenXon or
acXon should be done tacnully
• ReevaluaXon and summarizing –
– An essenXal role of the team leader is monitoring and
reevaluaXon of the status of the paXent, intervenXonsthat
have been done and assessment findings.
• Mutual Respect –
– The best teams are composed of members who share a
mutual respect for each other and work together in a
collegial, supporXve manner. All team members should
leave their egos at the door.

(Montgomery college, 2011 : Code Blue team : roles and funcXon)

 DocumentaXon
• CODE BLUE RECORD is uKlized for events that
occur during the code.
• The RN funcXoning as the recorder during the
code completes this form and a^aches any
perXnent monitor strips. The original code
blue record remains with the paXent record
and a copy is sent to the site specific designee
for audiXng.