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8. ��ࡱ� > �� ���� ������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������ / �� E bjbj�E�E L� �/�d�/�d� V �� �� �� � � � ���� ' ' ' 8 _ , � ' ] � � � � � � � � � �\ �\ �\ �\ �\ �\ �\ $ �_ � pb � �\ � � � @ � � �\ � � � �\ # # # � F � � �\ # � �\ # # �R � �X � ���� ��_߃� ���� ! [q(��53���׌�WU-@i&�8N�a�D��t�z�:��#m(�i)8��5��~����y-AGh��8�#���*�!��L!TE ՔH���S W��5�7���X�d� ��&����ɧq�ys� 5�Ye��u�j�GB�I=�nU�e5�3�6 0000002210 00000 n

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8. ��ࡱ� > �� ���� ������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������ / �� E bjbj�E�E L� �/�d�/�d� V �� �� �� � � � ���� ' ' ' 8 _ , � ' ] � � � � � � � � � �\ �\ �\ �\ �\ �\ �\ $ �_ � pb � �\ � � � @ � � �\ � � � �\ # # # � F � � �\ # � �\ # # �R � �X � ���� ��_߃� ���� ! [q(��53���׌�WU-@i&�8N�a�D��t�z�:��#m(�i)8��5��~����y-AGh��8�#���*�!��L!TE ՔH���S W��5�7���X�d� ��&����ɧq�ys� 5�Ye��u�j�GB�I=�nU�e5�3�6 0000002210 00000 n

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8. ��ࡱ� > �� ���� ������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������ / �� E bjbj�E�E L� �/�d�/�d� V �� �� �� � � � ���� ' ' ' 8 _ , � ' ] � � � � � � � � � �\ �\ �\ �\ �\ �\ �\ $ �_ � pb � �\ � � � @ � � �\ � � � �\ # # # � F � � �\ # � �\ # # �R � �X � ���� ��_߃� ���� ! [q(��53���׌�WU-@i&�8N�a�D��t�z�:��#m(�i)8��5��~����y-AGh��8�#���*�!��L!TE ՔH���S W��5�7���X�d� ��&����ɧq�ys� 5�Ye��u�j�GB�I=�nU�e5�3�6 0000002210 00000 n

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code blue documentation template

MET Dat… This material contains general information only and is not intended to be a substitute for advice from a safety expert, regulatory or legal counsel. Code holds the ultimate truth about your software. Williams K, Rideout J, Pritchett-k elly S, et al. Drip: 1mg/250ml--> (ml/hr) = wt x mcg/kg x 15. 6 0 obj << /Linearized 1 /O 8 /H [ 873 195 ] /L 56034 /E 54347 /N 1 /T 55797 >> endobj xref 6 22 0000000016 00000 n Process for Drill: Call for help and state �Code Blue� and location (or whatever the facility has designated for this circumstance� Describe scenario which is occurring (develop a script for situation (ie This is Mr. Jones, he is 93 years old, found him lying outside of the bathroom door and he has no pulse and no respirations) Identify a team leader for event (licensed nurse) Incorporate any facility specific policies and processes in this step not identified Team Leader assigns specific duties to staff: Verify residents code status (ensure during new staff orientation and ongoing this facility specific process is reviewed) Bring emergency/code cart to scene (ensure during orientation that all staff are shown where the emergency/code cart is stored) Initiate CPR/medical care/treatment Call 911 and give information Call physician and family Initiate emergency transfer forms Document the event and timeline Direct emergency services to location of event Mock Code Blue Checklist Observation This observation is intended to guide clinical staff through specific tasks and not intended to be all inclusive. Ask staff following questions: If resident is a code and CPR initiated when do you stop?Answers: When you are alone and physically exhausted and cannot continue When EMS is on the scene and takes over When the resident recovers-heart beating and breathing on their own Code Documentation Form Sample Event Date:Event Time:Location of Event: (ie room 212, east hall dining room)Time 911 called:Time EMS arrived at facility:CPR initiated at what time:CPR initiated by whom:List all that provided CPR, if more than person listed above: Documentation of vitals and time taken: BP, Respirations, Pulse, O2 saturation, O2 administered (route and how many liters): Time Resuscitation event concluded:Reason resuscitation ended: (check one) Return of circulation Efforts terminated per EMS Transferred to hospital Describe Events, if needed: (ie peripheral IV placed, response to interventions, any documentation not listed above) Resident Name PhysicianMedical Record Number Page PAGE 4 www.whcawical.org www.whcawical.org ! " Code is documentation. Was 911 called?Was emergency/code cart brought to room without incident?Did code cart have all needed equipment and all equipment current with no expired products?Was AED present, charged and all equipment available?

8. ��ࡱ� > �� ���� ������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������ / �� E bjbj�E�E L� �/�d�/�d� V �� �� �� � � � ���� ' ' ' 8 _ , � ' ] � � � � � � � � � �\ �\ �\ �\ �\ �\ �\ $ �_ � pb � �\ � � � @ � � �\ � � � �\ # # # � F � � �\ # � �\ # # �R � �X � ���� ��_߃� ���� ! [q(��53���׌�WU-@i&�8N�a�D��t�z�:��#m(�i)8��5��~����y-AGh��8�#���*�!��L!TE ՔH���S W��5�7���X�d� ��&����ɧq�ys� 5�Ye��u�j�GB�I=�nU�e5�3�6 0000002210 00000 n

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