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Roles and Responsibilities - SHED - Paediatric Code Nurse

Primary Roles

Respond to all Paediatric Code Blue and MET Calls within Sunshine Hospital and Joan Kirner Precincts (all clinical and non-clinical areas within hospital grounds). The PCN role acts as the team leader of the Paediatric Emergency Department space – managing the access and flow of patients within this area.

  • Assist in overall coordination of Paediatric ED:
    • Assist with cubicle allocations
    • Clinical support for the nursing team
    • Support nurses in ED to liaise with ED ANUM (NIC or Floor Coordinator)
    • Support nurses in ED to liaise with ward ANUM/NIC, ensuring timely and professional communication
  • Assist allocated Children’s Nurses in maintaining Paediatric patient flow to optimise patient safety. Transport the appropriate equipment to relevant clinical and non-clinical areas during Paediatric Code Blue/MET Calls:
    • PCN Broselow Trolleys to clinical areas (located in ED AV triage area; or in JKCW Level 6 resus trolley storage area)
    • Scoop and Run (RED) transfer bags to non-clinical areas (located in the Emergency Department (ED) Resuscitation Drug Room)
  • Ensure the PCN Broselow Trolleys in both ED and JKCW are checked and maintained as per requirements– including S11 medications being checked and double signed per shift.
  • Provide and receive handover to/from respective shifts and accept responsibility for the pager and phone. Handover should include:
    • Any paediatric patients at risk of deterioration within the ED or Joan Kirner Women’s & Children’s (JKWC) Ward Level 6.
    • Details of any code responses attended during the shift.
    • Resource or equipment issues pertaining to the PCN role (i.e. phone, trolley), and how these have or are required to be escalated.
  • Complete required documentation for ALL Paediatric Code Blue and MET Calls. (Documentation requirements detailed in “Methods of Documenting and Reporting” section below.)

Secondary Roles

  • Priority is to provide clinical assistance for unstable/potentially unstable paediatric patients in the Children’s ED area, Children’s triage, Children’s waiting room or ED resuscitation area. (e.g. paediatric BAT calls, paediatric emergency buzzers, unstable respiratory patients).
  • Check and maintain Children’s Negative Pressure room as per checklist.

Primary Workspace

  • Sunshine Hospital Emergency Department – Paediatric Staff Base Desk

Quality and Safety

  • Ensures the safety of self and colleagues by adhering to relevant Western Health OH&S, Hand Hygiene and PPE policies and procedures.
  • Ensures patient safety through regular checking and maintenance of code response trolleys as per WH Policy and Procedure requirements.
  • Ensures safety and quality by adhering to evidence-based practice guidelines and maintains own professional development.
  • Contributes to in-service education for the wider ED nursing team surrounding the PCN roles and responsibilities.


  • Effective communication is imperative. WH supports the use of the ISBAR handover format and closed loop communication strategies.
  • Primary ED contacts: ED NIC/ANUM, Paediatric ED Consultant/Senior Registrar/Medical staff, ED Resuscitation nursing staff, ED Triage nursing staff, ED Paediatric nursing staff, Adult Consultant/Senior Registrar, PSA’s, Security.
  • Primary JKCW Contacts: CW NIC/ANUM, CW CSRN, Paediatric Consultant/Senior Registrar/Medical staff, CW nursing staff, JK anaesthetics, AHA, PSA’s, Security.

Code Response Priorities

  • Introduce self, identify team and team leader, ensure allocation of roles. Receive brief ISBAR handover.
  • Perform standardised DRS-ABCDE assessment of patient.
  • PCN priorities include:
    • Providing advanced airway and/or breathing support as per APLS/critical care guidelines.
    • Preparing and administering specialised medications and/or IV fluids as per APLS/critical care guidelines.
    • Assisting with safe operation of defibrillator.
    • Coordinating plan of care with team leader and assisting with safe transfer if required (e.g. Theatre, ED, PIPER).
    • Completing relevant documentation.
  • Ensure clear communication of any stand-down order and participate in planning further care of patient.

Escalation Plan

  • Paediatric MET Call to be activated for any infant or paediatric patient meeting the following criteria:
    • A single vital sign in the purple zone on the ViCTOR chart
    • Three or more vital signs in the orange zone on the ViCTOR chart
    • Nurse or family member very worried about the child’s clinical state
    • No response to Urgent Clinical Review request within 30 minutes
    • NOTE: Escalation for paediatric patients in Sunshine ED who meet MET criteria is to occur through Primary ED contacts. If patient has been admitted by Paediatric admitting team but still in ED, then MET should be activated only after consultation with Paediatric ED medical staff.
  • Paediatric Code Blue to be activated for any child meeting the following:
    • Apnoea or cyanosis
    • Respiratory or cardiac arrest
    • Immediate threat to airway
    • Prolonged/non-resolving seizure activity
    • Sudden drop in conscious state
    • NOTE: Paediatric Code Blue must be activated within ED also.
  • During a Code Blue/MET call, if PCN requires further assistance with resources, staff or transfer, escalate to Access manager/AHA and liaise with the Paediatrician and/or senior Paediatric Medical Officer. (ED NIC/ANUM can be contacted for advice).

Methods of Documentation and Reporting

  • Within ED:
    • Paediatric Observation Flow Chart (AD 52.4) and age relevant ViCTOR chart.
    • At Triage, additional documentation to occur in EDIS clinical notes.
    • Medication Administration Record (MAR) must be co-signed accordingly on EMR.
  • Within JKCW:
    • Paediatric Code Blue/MET Form on Western Health Intranet Deteriorating Patient Committee team-site, this must be completed for every Code Blue/MET call. (Paper copy to be completed if team-site cannot be accessed, this must be scanned and forwarded to PCN Co-ordinators immediately).
    • Complete clinical documentation/progress notes on EMR detailing PCN assessments, interventions, outcomes and plan agreed to by team.

Measures of Success

  • All paediatric Code Blue and MET Calls attended in a timely manner.
  • PCN adheres to OH&S guidelines during transfer of relevant equipment.
  • Relevant documentation completed for ALL Code Blue or MET calls.
  • Deteriorating or acutely unwell paediatric patients identified, assessed and managed appropriately and efficiently, both within ED and JKCW.
  • PCN specific equipment checked and maintained as per policy and procedure requirements.
  • Current evidence based APLS guidelines followed during every Code Blue/MET call.
  • Clear communication with multidisciplinary team maintained during every Code Blue/MET call.
  • Paediatric 4 hour KPI target achieved at 81% or above.