ED Code Blue Response and Management Teams - Western Health Emergency Department

Overview

The introduction of ED Code Blue emergency calls within the Emergency Departments requires a standardized approach to response.

An ED Resus Team will be allocate on each clinical shift in the ED.

The ED Resus Team is responsible for responding to and managing any Code Blue/medical emergency within the ED.

If additional support is required, a hospital Code Response can be authorised by the senior medical officer and/or the ED NIC and will be called by dialling 2222.

Applicability

This procedure applies to adult and paediatric patients within all areas of the ED, including the Short Stay Unit (SSU) at SHED. It does not apply to

A maternal clinical emergency or imminent birth, which requires escalation via 2222 and calling the relevant maternal code
The remote SSU at Footscray, which is managed as per the usual ward processes.

Responsibility

It is the responsibility of the Directors of the Emergency Departments of each site to ensure the relevant staff are familiar with this QRG, that it is implemented according to the guidelines as outlined within, and that there is compliance by all staff members.

Guideline Details

Composition and responsibilities of the ED Resus Team varies according to the location of the clinical emergency within each ED is outlined in the following tables.

The senior medical officer in the ED Resus Team has oversight of the Code Blue resuscitation and responsibility for stand-down.

All members of the team should observe the PPE requirements during emergency response.

For further information about escalation and disposition, please refer to QRG Deteriorating Patient in ED.

ED Resus Teams according to site

SUNSHINE HOSPITAL ED CODE BLUE EMERGENCY BUZZER RESPONDERS
TRIAGE	AMBULANCE VICTORIA (AV) CORRIDOR
ED NIC Resus Nurse 1 Nurse who activated the buzzer Waiting Room Nurse Paediatric Code Nurse (PCN) if required Resus Registrar +/- Consultant (0730 – 2400) For children: Children’s Registrar +/- Consultant (0800 – 2330) PSA x2 Security (if outside)	ED NIC Resus Nurse 1 Nurse who activated the buzzer PCN if required Resus Registrar +/- Consultant (0730 – 2400) For children: Children’s Registrar +/- Consultant (0800 – 2330) PSA x2
RESUS	ADULT ACUTE & FAST TRACK
ED NIC Resus Nurse 1 Nurse who activated the buzzer PCN if required Resus Registrar +/- Consultant (0730 – 2400) PSA	ED NIC Resus Nurse 1 Nurse who activated the buzzer PCN if required Resus Registrar +/- Consultant (0730 – 2400) PSA
SHORT STAY UNIT (SSU)	CHILDREN’S AREA
SSU NIC ED NIC Resus Nurse 1 Nurse who activated the buzzer SSU Registrar +/- Consultant (0730 – 2300) Resus Registrar PSA	ED NIC Resus Nurse 1 Nurse who activated the buzzer PCN Children’s Registrar +/- Consultant (0800 – 2330) Resus Registrar PSA
WESTCASA (LEVEL ONE)	ADMINISTRATION AREA (LEVEL TWO)*
ED NIC Resus Nurse 1 Nurse who activated the buzzer Resus Registrar +/- Consultant (0730 – 2400) PSA	Hospital MET or Code Blue Team Resus Registrar ED NIC Resus Nurse 1 Staff member who activated the buzzer

FOOTSCRAY HOSPITAL ED CODE BLUE EMERGENCY BUZZER RESPONDERS

All ED areas except triage and SSU	Triage	SSU
ED NIC Resus Nurse 1 Nurse who activated the buzzer Resus Registrar Patient Services Assistant (PSA)	+ security if outside	SSU NIC instead of ED NIC SSU Consultant / Night ED Registrar instead of resus registrar

WILLIAMSTOWN HOSPITAL ED CODE BLUE EMERGENCY BUZZER RESPONDERS

All areas

ED NIC
Senior ED Nurse
Nurse who activated the buzzer
Career Medical Officer
Junior Medical Officer
PSA

ED Resus Team responder role definition

RESPONDER	ROLE
TEAM LEADER ED Registrar +/- Consultant or Career Medical Officer (CMO)	Identifies self and leadership role within the team Conducts the resuscitation using the advanced life support (ALS) algorithms Escalates to senior/specialised medical clinicians as required Authorises transfer of patient to higher acuity area as required Authorises hospital Adult Code Blue if indicated and authorises Code Blue stand down when safe to do so
Junior Medical Officer	Works collaboratively with the ED Registrar/Consultant/CMO Provides ALS management skills in line with ANZCOR Conducts the resuscitation using the ALS algorithm Ensures documentation of drugs, interventions, etc. Communicates with family
NIC	Authorises hospital Adult Code Blue if indicated Establishes safe disposition for the patient and makes arrangement for Resus bed as required
Resus Nurse or PCN	Brings relevant Code Responder Trolley Provides ALS support, including managing the use of the defibrillator and assisting with airway management as required Supervises drawing up and administration of emergency IV medications Completes the Adult or Paediatric Code Blue audit tool
Bedside Nurse/Triage Nurse	Initiates BLS, activates emergency buzzer Supports ALS team Ensures adequate documentation Provides care of family
PSA	Assists team as required for transfer or obtaining equipment
Security	Oversight of staff safety and provision of crowd control in public areas such as Triage Assists team as required for transfer or obtaining equipment

Documentation & Communication

Any UCR, MET Call or Code Blue should be documented both in medical clinical notes and in the nursing observation chart.

Any episode should be communicated in nursing handover.

Stand-Down

The Team Leader can stand down the ED Code Blue/medical emergency once the situation is under control. The following are required as part of the Stand-Down process:

Provide a verbal summary of the event and action plan to the bedside and response clinicians in an ISBAR format
Check with all members for questions or concerns about the plan
Check that the lead medical specialist (or delegate) of the patient’s treating unit has been notified, if not already involved in care and decision making during activation
Ensure that event documentation is completed by assigned personnel
Ask for feedback from staff regarding system issues, team issues or any latent safety threats uncovered during the activation to be communicated either via the Adult or Paediatric MET/Code Blue Audit tool, MET register or RiskMan, dependent on the severity of the risk/concern
Clearly authorise to STAND DOWN the team

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