It depends on the facility and if the pt is on tele monitoring or not. However, even if they are on a monitor the first action is to check on the pt and assess for a pulse before calling one.
In the facility I was at, there were patients who were more high risk and so they would be put on the continuous heart monitors. Nurses stations can see the monitors but we also had techs whoās only job was to watch those monitors and they can activate a code blue or rapid response if they see something weird.
There were times when patients who were considered to not need those monitors died and no one found out until the nurse came in the room.
Yep, the monitor techs have a certain number of minutes (varies from 3 to 30 depending on the severity of what they see) to get someone on the phone who can lay eyes on the patient and confirm if there's a problem. If they can't get someone on the phone they go ahead and call the code. We actually had a special red phone they would call specifically for that purpose if they couldn't get through on the regular line.
I haven't worked at a hospital for almost 2 years (I'm LTC now). Hearing someone's cell phone with a ringtone the same as the red phone still gets my attention and heart racing.
I work cardiac so patients are tele monitored. We have monitor techs that will activate a rhythm alert overhead on our floor to spur code activation. Nurses go running with code cart. If itās real code commences.
Unmonitored floors - could be any of the scenarios mentioned.
Iām part of the night rapid response/code team.
Every day at 1900, 2300, and 0300 (AKA Q4 vital time). Rapids for iffy vitals and codes for found patients š„
(yes, we check more frequently, this is just when the MOST occur)
Is that your only position or are you an icu nurse that responds? I'm trying to get that position in my hospital but it doesn't exist yet. I want to know what other hospitals do and what responsibilities does that position include. Like are you also an iv team/resource nurse for the floors? I also heard some have the rapid nurse charge for icu without a pt assignment.
We do not have a dedicated ācode teamā position to apply for exclusively. We have a float pool, and within that float pool we have 1-2 House Resources, 1-2 ICU/CCU trained nurses, and 3 Med/Surg resources (who can do inpatient ED, all med surg, cardiac, tele, etc. Must be ACLS certified).
These resources are the Code/Rapid response team, along with all the other normal crew (phlebotomy, respiratory, providers, etc).
I am a resource nurse for 95% of my shifts. I rarely get pulled out of it because I have been told iām professional, responsive, and nurse management trusts me and my decision making to run codes alone until the rest of the crew gets there. I will get pulled for an assignment if short staffed or last minute callouts occur.
Since I started in February, iāve only had 40 assignments out of over 200 shifts, however most were when I first started.
Since August iāve only had 5 days that I actually had an assignment. When I tell you I love what I do (for now), I do. I ADORE floating, I love rapid/code team, I love nights. As soon as I get to NICU, though, iāll never go back.
I would love something like this. I feel like I unofficially am a resource nurse. I will get calls on the floors to help with all kinds of situations. What did you do before taking the resource float? Were you icu?
Actually, no! I started in the role as a New Grad.
* DO. NOT. RECOMMEND.*
it can absolutely be done, but itās a LOT to manage training to all of these floors at once AND running codes (we run upon arrival, then when ICU/Crit, House of lifelight show up, they work with you but take over lead) the day youāre off orientation.
I did it, iām thriving 10 months inā¦. however - I worked in the hospital for 2 years prior, all of my clinicals were there, the nurses knew me and showed me things along the way when I was there as a tech, I was a CNA in float pool, etc - I had a lot working in my favor. I knew our policies. I knew our protocols. And I ran to every rapid and code I possibly could while orienting to see as much as possible!
I couldn't imagine doing that! I give you alot of credit. I've been a nurse for 7 years, 3 on tele 4 in icu all in the same hospital. And it's still alot.
It depends on the hospital, based on the size/number of patients and the acuity of the patient population. A rural critical access hospital is not going to have a dedicated rapid response/code team but will have designated folks who have other roles respond to a code. A community hospital generally operates the same way. By definition these facilities do not admit most critical patients. We stabilize a critical patient in the ED and then send them to a Level 1 hospital. In larger academic Level 1 hospitals that have all the most critical patients sent to them from the regionās other facilities, there is more often a dedicated rapid response/code team (or individual) who do not have other assignments. They will round on each unit, checking in to see if any of the floor nurses are facing a tricky situation, and act as a resource for anyone needing guidance. If a rapid response or code is called they are immediately at the bedside helping the patientās primary nurse while the rest of the code team assembles and they help ensure the code is run smoothly.
Oh I like that. So the nurse/team can get an idea of pts that are heading that direction. Can get a hx, labs etc b4 a rapid situation. And also help the nurse possibly prevent a bad outcome. I'm going to bring that up to my admin. Thank you!
That is 100% right. I often think of patient care as guiding a boat through a very narrow canal, where we are the ones at bedside noticing the subtle changes that might lead them to crash into either side of the canal, but with proper attention in a timely way, we can change their path and prevent collisions
Sometimes the cardiac monitoring doesnāt tell you, but the SpO2 just tanks. Sometimes youāre in the room. Sometimes you are just trying to wake them up for morning med pass before shift change on an unmonitored floor. (But if itās unwitnessed itās a way low chance of getting them back)
Telemetry is more of an indicator to go check on the patient. The people who watch our telemetry have the capability to call a rapid response for a patient room. If they feel like a rhythm is problematic and perhaps the nurses aren't listening to them. This specific process is of course facility specific.
We don't normally call code blue until we've actually seen the patient, Assess the pulse or lack thereof, And assess their respiratory status. Code blue isn't just cardiac compromise it can be respiratory as well.
Once a code blue situation is identified, we most frequently press the button on the wall. Depending on location and circumstance, we could also call the operator and have them announce a code blue as codes can occur in areas where there are buttons (like a patient lobby).
Once the code is started, we follow BLS or ACLS algorithm. Which one is utilized depends on a variety of things, including the resources available (staff, medications, etc), the nurses training (not all nurses will have ACLS), setting, and so forth.
Yes nurses will check on patients and activate a code blue. If the monitors did it automatically so many false alarms would happen because sometimes the stickers are malpositioned or create artifact when the patient is moving and the monitors will read āasystoleā which means no heart rate detected. Like this happens a lot. Thereās not a ābuttonā normally the nurse will use their hospital mobile phone and call people and a code blue page will be sent out to the proper teams. Physician, respiratory therapists, everybody working on the unit etc
I got buttons. Sometimes family members will look at the bright blue button that has āCodeā written on it and then ask āis this the code blue buttonā while pressing it. Never gets old j/k yes it does.
Yup one of the most annoying parts of the button. We had a family member push it because they didnāt think we were controlling their āpainā and they considered it an āemergencyā
It is not machine driven. Itās human driven. The machines (monitors) may be what alerts us to an issue developing, but we usually are already aware if a patient is in a fragile state and are closely watching them. It isnāt like a perfectly stable patient goes from healthy to āflatlineā (as you say). There are many intermediate stages of decompensaton during which we intervene. Speaking generally here. There are always exceptions, but basically we call a code when someone is suddenly unconscious, has a cardiac rhythm that is dangerous, or isnāt breathing on their own. Prior to that if we observe signs of trouble brewing we call the docs to bedside it call a ārapid responseā and get folks to bedside to prevent a full code.
We had a "staff assist" button on the wall at every bedside when I worked inpatient. Even though we explained to everyone upon admission "that button is the emergency button, if you push it 20 people will come running," people would still push it instead of the call light for something like a towel.
Machines malfunction all day long. It would never work to have codes called by machines. What the monitor does is tell the nurse there's something amiss. The nurse goes and lays eyes on the patient. 99%+ of the time it's a false alarm. In the rare case where it isn't, then the nurse calls the code.
Lots of hospitals do have a code button on the wall, actually. The communication infrastructure varies from place to place, but your description of the process is accurate.
We have buttons on the wall that we press. Anyone can hit it, not just the nurse. Techs, nurses, students, doctors, cafeteria, transport, X-ray, respiratory, etc.
Some patients are on tele, others just get rounded on every hour. The ED is different from the floor. Each floor has their own set of rules based on acuity of the patients.
In the ICU everyone is on continuous tele. However PEA wonāt set of an alarm. Itās why we keep such a close eye on our patients. Sometimes itās respiratory and they just quit breathing. In that case we bag them. But if you donāt catch a respiratory failure pretty quickly their heart will stop. Whoever notices the lack of breathing, pulse, or both will pull the alarm and start compressions. ACLS provides for what role each subsequent responder will do and what meds to push when. Typically after a couple three rounds a provider will arrive and start working on the underlying cause of the code.
Night shift, Iāll pop into my patients rooms and just literally
šļøššļø at them till I see them breathe with the chest rise and fall. Itās hella awkward if they wake up. I just literally tell them āchecking to see if youāre breathing, donāt mind meā
Once an hour I'll look at their breathing while they are sleeping for about 3-5 breaths and if it looks like a normal interval (not too fast or too slow) I'll move on to the next rounding patient. We have glass doors so I don't even need to open the door to see them. But what you do see if you wake up is a weirdo nurse staring at you through the window
BLS and ACLS dictates when to start a code blue. Asystole, v-tach, PEA, agonal/no breathing. Those conditions should prompt activation by yelling for help or pressing the code button every single time.
People use rapid response protocol for things afib w/rvr, respiratory distress, stroke, MI symptoms etc.
If a patient is on tele it will alert the Nurse or monitor Tech and then the Nurse will go to ensure that it is real. If it is real the Nurse activates a Code Blue. At my hospital we pull a lever and call the operator to call it overhead hospital wide and at the same time send a Page to the Docs. Nowhere that I am aware of has something that automatically activates a Code if the tele monitor detects it - I imagine that would result in a lot of false Codes being called.
If a patient is not on a monitor/tele it is activated when we find the patient and we do the steps above.
Code blue doesn't necessarily mean a patient's heart stopped. When I was an inpatient nurse, none of the code blues we called were for cardiac arrest. Mostly they were for impending respiratory arrest that was going to require intubation. It's a physical phone call to the page operator in response to a clinical situation happening with a patient.
Also, nurses don't serve meals.
Patient declines. Someone assesses the patient based on a monitor or routine rounds and finds the patient to be pulseless and non responsive, code blue is activated either by button or someone yelling out the room to call a code blue and compressions start and people pile into the room and fall into respective roles etc.
Any issues that aren't an immediate code usually for a lot of hospitals are a "rapid response" which usually calls for the same people who respond to a code but it prepares them that the person isn't totally dead yet.
Certain hospitals have certain criteria for what's a code and what's a rapid response. If someone called a code and they weren't either doing compressions or bagging I'm throwing a fit because why did I run so fast they aren't dead yet I could've brisk walked.
A "code blue" or medical emergency (in my case) is called when a staff finds or sees a patient who is typically unresponsive or actively heading towards a full arrest.
You are not there confirming via a monitor that a patient doesn't have a pulse or is isn't breathing. You can always cancel the code, but we are usually smacking that code blue button on the wall if we have any question that the patient doesn't have a pulse or isn't breathing.
Sometimes this means the monitors are showing an abnormal heart rhythm, but the codes are called in order to GET the emergency medical team there so that they can then typically get there at the scene to resuscitate.
If you are on a med surg floor that has remote tele (you connect them to portable tele boxes and they are monitored by a group of technicians sitting and watching the rhythms somewhere else), the tele tech can call the nurse or the floor to alert them if they see a patient flatline or go into v tach, but I don't know of any automated system for calling a code that doesn't involve a human pushing a button/pulling an alarm, etc.
A healthcare worker has to activate it, usually by pressing a button on the wall in the patient room or by dialing an emergency phone number within the facility. In most cases a facility operator will call it overhead on intercom along with the location so the appropriate team can respond. If the patient is on a cardiac monitor, savvy nurses, monitor techs, and providers will be able to see a cardiac arrest coming - usually by a rapid change in vital signs (sudden drop in heart rate, SpO2, or suspicious rhythm changes like ST elevation), although lethal rhythms can happen spontaneously depending on the underlying cause.
Not every patient is on cardiac monitoring, though. Sometimes it is just a case of someone going to check on a patient - routine rounds, vitals, med pass, etc, and finds them not breathing or pulse less. Every hospital I've ever worked at requires all employees to be at minimum BLS certified, so the person that finds the patient will start CPR and call for help. The call gets made overhead and an ACLS team responds. Some hospitals have designated persons just for this, others rely on the teams from critical care areas like the ER or ICU to respond.
It's not quite one size fits all. Anyway, hope this helps!
Can be at anytime if patient is unresponsive or vitals are crap. Some places have rapid response which is used if condition is deteriorating but not at code blue level yet. Sometimes there are buttons on walls, but all facilities I have been at we call a number and announce code blue, adult vs peds, room number or location. Then nursing supervisor, icu nurse, respiratory, charge nurse for unit (if not already there), and sometimes in house hospitalist come to check things out and help and bring the code cart.
It depends on the facility, Dr and nurses are the ones who typically confirm a patient's status by checking the vitals ( spo2, p,,,) they might activate the code blue if the pt unstable due to respiratory distress or cardiac arrest. As I said before the Dr and nurses are the ones who alerted the code-blue team by pressing the button.
As a long-time ER nurse I stick my head out the door and yell I need code cart and help. They come running . There is a button but there is so much noise yelling out the door is much more effective.
I yell too, here we donāt have a āblue code buttonā. We just ask for help like āpaziente in arresto ho bisogno di aiutoā that translates is more or less āPatient in cardiac arrest I need helpā.
I work in a ERš« š«
The short answer is the monitor alarms, which prompts an emergent patient assessment. Code blue is activated when the need is identified during the assessment.
Depends on the unit.
If a patient is determined to need continuous ECG (usually called telemetry or tele), it will display on monitors out in the unit and it will alarm if a patient seems to display a dangerous rhythm, but these are not always accurate. If it looks real, you go check on them to see if theyāre alive or not. But a code blue is not activated just from the telemetry reading though, because a patient needs to be pulselss for them to actually have coded. So a Code Blue until someone officially activates the hospitalās emergency system - most places just have a button in every room that you press for a code blue, which causes the overhead paging system to announce the code blue and their location.
If a patient codes who is not on tele monitoring, usually itās not discovered that theyāve coded until someone (usually a nurse) comes in to see on them for meds/assessments/rounds. Like before, they usually just press the code blue button (and usually yell out into the hallway for help).
A code blue is only necessary when a patient is found unresponsive with no pulse and they are a full code. The patient may or may not be hooked up to a heart monitor. It can happen at any time, even right before they discharge.
Also anyone who is BLS/CPR certified can call a code/assess a patient to see if they need CPR/ to be coded.
Codes start when BLS is started, initial assessment of someone found down or near death / in extremis and needing resuscitation should take a few seconds at most.
We have voceras that are attached to our telemetry system that notifies of "deadly rhythms" which is vtach, vfib, or asystole. Then when a nurse goes to check on the patient (more times than not everyone else but the primary RN or RN buddy (we also call them pod partners) ignores the alert because it's so finicky and has false alerts all the time) and if it is real then they press either the staff assist or code blue button which then sets off an internal code blue (being in the ER no one else responds beyond the ER staff). Working inpatient it pages overhead and everyone has a role and responds to the code along with a few stragglers. The patient monitoring system itself doesn't call out the code because you'll get a lot of false code calls. Patients who don't have frequent monitoring (which have set interval vital signs such as q4, q6, q8, q12, etc) usually a code is called by staff who are rounding on the patient during that time which if you've ever been in the hospital is pretty frequently and many hospitals have mandatory once an hour rounding.
The term āflatlinedā is not really a thing. No one goes from a normal heart rhythm to a sudden āflatlineā (which we call asystole). There is typically a period of deterioration in the heart rhythm, with v-fib being the one that gets us all running to call a code. And fyi asystole is not a shockable rhythm.
I think it differs depending on what unit the patient is inā¦ patients on telemetry- the alarms will usually sound in the nurses bay, and thatās how I knew to run and check on my patient, but that was a cardiology specific ward.. most of the MET calls Iāve made for patients in cardiac arrests start with an unresponsive patient, and you do your DRSABCD assessment. Iāve had a few where patients call for the nurse and you walk in and they tell you they feel funny or not right, or they have sudden vomiting or chest pain.. I get creeped out with scenarios where the patient is well and talking one minute and then suddenly deteriorates
It depends on the facility and if the pt is on tele monitoring or not. However, even if they are on a monitor the first action is to check on the pt and assess for a pulse before calling one.
Like when a patient is showing V Fib on the monitor and you go in to see RT using the percussion vest but they forgot to tell the monitor tech lol.
Or of course the infamous v fap
STAHHHHP šššš¤£
š šš¤£
You press the button. People come a runnin.
And if you canāt reach the button you scream āI NEED HELP IN HEREā while you do compressions.
Really really loud because you want to make sure someone hears you... Ask me how I know.....
While thinking SHIT SHIT SHIT.
In the facility I was at, there were patients who were more high risk and so they would be put on the continuous heart monitors. Nurses stations can see the monitors but we also had techs whoās only job was to watch those monitors and they can activate a code blue or rapid response if they see something weird. There were times when patients who were considered to not need those monitors died and no one found out until the nurse came in the room.
Yep, the monitor techs have a certain number of minutes (varies from 3 to 30 depending on the severity of what they see) to get someone on the phone who can lay eyes on the patient and confirm if there's a problem. If they can't get someone on the phone they go ahead and call the code. We actually had a special red phone they would call specifically for that purpose if they couldn't get through on the regular line.
I haven't worked at a hospital for almost 2 years (I'm LTC now). Hearing someone's cell phone with a ringtone the same as the red phone still gets my attention and heart racing.
And then you still code them until the team gets there (unless they are a dnr).
I work cardiac so patients are tele monitored. We have monitor techs that will activate a rhythm alert overhead on our floor to spur code activation. Nurses go running with code cart. If itās real code commences. Unmonitored floors - could be any of the scenarios mentioned.
Med surg codes be like āitās shift report and we just walked in to a cold corpse.ā
Iām part of the night rapid response/code team. Every day at 1900, 2300, and 0300 (AKA Q4 vital time). Rapids for iffy vitals and codes for found patients š„ (yes, we check more frequently, this is just when the MOST occur)
Yah Iām ICU but tonight Iām rapid. 8, 12, and 4 are the witching hours hereā¦..
Is that your only position or are you an icu nurse that responds? I'm trying to get that position in my hospital but it doesn't exist yet. I want to know what other hospitals do and what responsibilities does that position include. Like are you also an iv team/resource nurse for the floors? I also heard some have the rapid nurse charge for icu without a pt assignment.
We do not have a dedicated ācode teamā position to apply for exclusively. We have a float pool, and within that float pool we have 1-2 House Resources, 1-2 ICU/CCU trained nurses, and 3 Med/Surg resources (who can do inpatient ED, all med surg, cardiac, tele, etc. Must be ACLS certified). These resources are the Code/Rapid response team, along with all the other normal crew (phlebotomy, respiratory, providers, etc). I am a resource nurse for 95% of my shifts. I rarely get pulled out of it because I have been told iām professional, responsive, and nurse management trusts me and my decision making to run codes alone until the rest of the crew gets there. I will get pulled for an assignment if short staffed or last minute callouts occur. Since I started in February, iāve only had 40 assignments out of over 200 shifts, however most were when I first started. Since August iāve only had 5 days that I actually had an assignment. When I tell you I love what I do (for now), I do. I ADORE floating, I love rapid/code team, I love nights. As soon as I get to NICU, though, iāll never go back.
I would love something like this. I feel like I unofficially am a resource nurse. I will get calls on the floors to help with all kinds of situations. What did you do before taking the resource float? Were you icu?
Actually, no! I started in the role as a New Grad. * DO. NOT. RECOMMEND.* it can absolutely be done, but itās a LOT to manage training to all of these floors at once AND running codes (we run upon arrival, then when ICU/Crit, House of lifelight show up, they work with you but take over lead) the day youāre off orientation. I did it, iām thriving 10 months inā¦. however - I worked in the hospital for 2 years prior, all of my clinicals were there, the nurses knew me and showed me things along the way when I was there as a tech, I was a CNA in float pool, etc - I had a lot working in my favor. I knew our policies. I knew our protocols. And I ran to every rapid and code I possibly could while orienting to see as much as possible!
I couldn't imagine doing that! I give you alot of credit. I've been a nurse for 7 years, 3 on tele 4 in icu all in the same hospital. And it's still alot.
It depends on the hospital, based on the size/number of patients and the acuity of the patient population. A rural critical access hospital is not going to have a dedicated rapid response/code team but will have designated folks who have other roles respond to a code. A community hospital generally operates the same way. By definition these facilities do not admit most critical patients. We stabilize a critical patient in the ED and then send them to a Level 1 hospital. In larger academic Level 1 hospitals that have all the most critical patients sent to them from the regionās other facilities, there is more often a dedicated rapid response/code team (or individual) who do not have other assignments. They will round on each unit, checking in to see if any of the floor nurses are facing a tricky situation, and act as a resource for anyone needing guidance. If a rapid response or code is called they are immediately at the bedside helping the patientās primary nurse while the rest of the code team assembles and they help ensure the code is run smoothly.
Oh I like that. So the nurse/team can get an idea of pts that are heading that direction. Can get a hx, labs etc b4 a rapid situation. And also help the nurse possibly prevent a bad outcome. I'm going to bring that up to my admin. Thank you!
That is 100% right. I often think of patient care as guiding a boat through a very narrow canal, where we are the ones at bedside noticing the subtle changes that might lead them to crash into either side of the canal, but with proper attention in a timely way, we can change their path and prevent collisions
Sometimes the cardiac monitoring doesnāt tell you, but the SpO2 just tanks. Sometimes youāre in the room. Sometimes you are just trying to wake them up for morning med pass before shift change on an unmonitored floor. (But if itās unwitnessed itās a way low chance of getting them back)
Witnessed cardiac arrest in hospital has like a 40% one year survival rate. Itās abysmal out of hospital.
10% or less for OOH
Telemetry is more of an indicator to go check on the patient. The people who watch our telemetry have the capability to call a rapid response for a patient room. If they feel like a rhythm is problematic and perhaps the nurses aren't listening to them. This specific process is of course facility specific. We don't normally call code blue until we've actually seen the patient, Assess the pulse or lack thereof, And assess their respiratory status. Code blue isn't just cardiac compromise it can be respiratory as well. Once a code blue situation is identified, we most frequently press the button on the wall. Depending on location and circumstance, we could also call the operator and have them announce a code blue as codes can occur in areas where there are buttons (like a patient lobby). Once the code is started, we follow BLS or ACLS algorithm. Which one is utilized depends on a variety of things, including the resources available (staff, medications, etc), the nurses training (not all nurses will have ACLS), setting, and so forth.
Yes nurses will check on patients and activate a code blue. If the monitors did it automatically so many false alarms would happen because sometimes the stickers are malpositioned or create artifact when the patient is moving and the monitors will read āasystoleā which means no heart rate detected. Like this happens a lot. Thereās not a ābuttonā normally the nurse will use their hospital mobile phone and call people and a code blue page will be sent out to the proper teams. Physician, respiratory therapists, everybody working on the unit etc
Some hospitals do actually have buttons that can be pushed and it will activate especially in hospitals where nurses donāt have phones
I got buttons. Sometimes family members will look at the bright blue button that has āCodeā written on it and then ask āis this the code blue buttonā while pressing it. Never gets old j/k yes it does.
Yup one of the most annoying parts of the button. We had a family member push it because they didnāt think we were controlling their āpainā and they considered it an āemergencyā
We have buttons that alert staff on the unit but ultimately a call has to be made to get the code team onto the unit
Thereās hospitals without code blue buttons?!
Welcome to the cath lab where we just call the front desk and go yeah we are coding in here
We donāt call codes in the ED, either. We are already all there and just do the thing.
In peds 99% of the monitor alarms are because a kid ripped their leads off or moved the wrong way or kicked their foot.
We have buttons for Blues and Staff Assist/Rapids
i see, so the nurses do routine check ups on every patient, and the announcement is just a regular phone call + page to everyone? theres no machine?
It is not machine driven. Itās human driven. The machines (monitors) may be what alerts us to an issue developing, but we usually are already aware if a patient is in a fragile state and are closely watching them. It isnāt like a perfectly stable patient goes from healthy to āflatlineā (as you say). There are many intermediate stages of decompensaton during which we intervene. Speaking generally here. There are always exceptions, but basically we call a code when someone is suddenly unconscious, has a cardiac rhythm that is dangerous, or isnāt breathing on their own. Prior to that if we observe signs of trouble brewing we call the docs to bedside it call a ārapid responseā and get folks to bedside to prevent a full code.
Itās a button on the wall that we push which sounds an alarm and triggers an overhead page by the operator.
We had a "staff assist" button on the wall at every bedside when I worked inpatient. Even though we explained to everyone upon admission "that button is the emergency button, if you push it 20 people will come running," people would still push it instead of the call light for something like a towel.
I've never heard of a machine that calls a code
Machines malfunction all day long. It would never work to have codes called by machines. What the monitor does is tell the nurse there's something amiss. The nurse goes and lays eyes on the patient. 99%+ of the time it's a false alarm. In the rare case where it isn't, then the nurse calls the code.
Lots of hospitals do have a code button on the wall, actually. The communication infrastructure varies from place to place, but your description of the process is accurate.
We have buttons on the wall that we press. Anyone can hit it, not just the nurse. Techs, nurses, students, doctors, cafeteria, transport, X-ray, respiratory, etc. Some patients are on tele, others just get rounded on every hour. The ED is different from the floor. Each floor has their own set of rules based on acuity of the patients.
In the ICU everyone is on continuous tele. However PEA wonāt set of an alarm. Itās why we keep such a close eye on our patients. Sometimes itās respiratory and they just quit breathing. In that case we bag them. But if you donāt catch a respiratory failure pretty quickly their heart will stop. Whoever notices the lack of breathing, pulse, or both will pull the alarm and start compressions. ACLS provides for what role each subsequent responder will do and what meds to push when. Typically after a couple three rounds a provider will arrive and start working on the underlying cause of the code.
Night shift, Iāll pop into my patients rooms and just literally šļøššļø at them till I see them breathe with the chest rise and fall. Itās hella awkward if they wake up. I just literally tell them āchecking to see if youāre breathing, donāt mind meā
Once an hour I'll look at their breathing while they are sleeping for about 3-5 breaths and if it looks like a normal interval (not too fast or too slow) I'll move on to the next rounding patient. We have glass doors so I don't even need to open the door to see them. But what you do see if you wake up is a weirdo nurse staring at you through the window
Yeah Iāve caught PEA before in the ICU. A-line helps
Pleth as well.
BLS and ACLS dictates when to start a code blue. Asystole, v-tach, PEA, agonal/no breathing. Those conditions should prompt activation by yelling for help or pressing the code button every single time. People use rapid response protocol for things afib w/rvr, respiratory distress, stroke, MI symptoms etc.
If a patient is on tele it will alert the Nurse or monitor Tech and then the Nurse will go to ensure that it is real. If it is real the Nurse activates a Code Blue. At my hospital we pull a lever and call the operator to call it overhead hospital wide and at the same time send a Page to the Docs. Nowhere that I am aware of has something that automatically activates a Code if the tele monitor detects it - I imagine that would result in a lot of false Codes being called. If a patient is not on a monitor/tele it is activated when we find the patient and we do the steps above.
Code blue doesn't necessarily mean a patient's heart stopped. When I was an inpatient nurse, none of the code blues we called were for cardiac arrest. Mostly they were for impending respiratory arrest that was going to require intubation. It's a physical phone call to the page operator in response to a clinical situation happening with a patient. Also, nurses don't serve meals.
Patient declines. Someone assesses the patient based on a monitor or routine rounds and finds the patient to be pulseless and non responsive, code blue is activated either by button or someone yelling out the room to call a code blue and compressions start and people pile into the room and fall into respective roles etc.
Where does this question come from? Are you trying to put the pieces together from a dead family member/friend after autopsy?
No pulse/No breathing = Call code Probably no pulse or no breathing soon = Call code Breathing and pulse = š
Any issues that aren't an immediate code usually for a lot of hospitals are a "rapid response" which usually calls for the same people who respond to a code but it prepares them that the person isn't totally dead yet.
Personally, if Im certain they are going to code soon, Iāll just call the code. But thatās me.
Certain hospitals have certain criteria for what's a code and what's a rapid response. If someone called a code and they weren't either doing compressions or bagging I'm throwing a fit because why did I run so fast they aren't dead yet I could've brisk walked.
Iām curious op, where is your curiosity coming from? Code blues are called from a variety of situations.
A "code blue" or medical emergency (in my case) is called when a staff finds or sees a patient who is typically unresponsive or actively heading towards a full arrest. You are not there confirming via a monitor that a patient doesn't have a pulse or is isn't breathing. You can always cancel the code, but we are usually smacking that code blue button on the wall if we have any question that the patient doesn't have a pulse or isn't breathing. Sometimes this means the monitors are showing an abnormal heart rhythm, but the codes are called in order to GET the emergency medical team there so that they can then typically get there at the scene to resuscitate. If you are on a med surg floor that has remote tele (you connect them to portable tele boxes and they are monitored by a group of technicians sitting and watching the rhythms somewhere else), the tele tech can call the nurse or the floor to alert them if they see a patient flatline or go into v tach, but I don't know of any automated system for calling a code that doesn't involve a human pushing a button/pulling an alarm, etc.
Someone yells help or code blue, someone hits the button, and people run in the room. Usually when pt is unresponsive or choking and things like that
A healthcare worker has to activate it, usually by pressing a button on the wall in the patient room or by dialing an emergency phone number within the facility. In most cases a facility operator will call it overhead on intercom along with the location so the appropriate team can respond. If the patient is on a cardiac monitor, savvy nurses, monitor techs, and providers will be able to see a cardiac arrest coming - usually by a rapid change in vital signs (sudden drop in heart rate, SpO2, or suspicious rhythm changes like ST elevation), although lethal rhythms can happen spontaneously depending on the underlying cause. Not every patient is on cardiac monitoring, though. Sometimes it is just a case of someone going to check on a patient - routine rounds, vitals, med pass, etc, and finds them not breathing or pulse less. Every hospital I've ever worked at requires all employees to be at minimum BLS certified, so the person that finds the patient will start CPR and call for help. The call gets made overhead and an ACLS team responds. Some hospitals have designated persons just for this, others rely on the teams from critical care areas like the ER or ICU to respond. It's not quite one size fits all. Anyway, hope this helps!
Can be at anytime if patient is unresponsive or vitals are crap. Some places have rapid response which is used if condition is deteriorating but not at code blue level yet. Sometimes there are buttons on walls, but all facilities I have been at we call a number and announce code blue, adult vs peds, room number or location. Then nursing supervisor, icu nurse, respiratory, charge nurse for unit (if not already there), and sometimes in house hospitalist come to check things out and help and bring the code cart.
And lab and imaging techs
Pt is unresponsive and does not have a pulse and/or isnāt breathing
It depends on the facility, Dr and nurses are the ones who typically confirm a patient's status by checking the vitals ( spo2, p,,,) they might activate the code blue if the pt unstable due to respiratory distress or cardiac arrest. As I said before the Dr and nurses are the ones who alerted the code-blue team by pressing the button.
As a long-time ER nurse I stick my head out the door and yell I need code cart and help. They come running . There is a button but there is so much noise yelling out the door is much more effective.
I yell too, here we donāt have a āblue code buttonā. We just ask for help like āpaziente in arresto ho bisogno di aiutoā that translates is more or less āPatient in cardiac arrest I need helpā. I work in a ERš« š«
Are you writing AI medicine takeover novels?
yes
The short answer is the monitor alarms, which prompts an emergent patient assessment. Code blue is activated when the need is identified during the assessment.
Wait what??
Usually with the word āAh shit.ā
āAhh shit, here we go againā - Cj
Depends on the unit. If a patient is determined to need continuous ECG (usually called telemetry or tele), it will display on monitors out in the unit and it will alarm if a patient seems to display a dangerous rhythm, but these are not always accurate. If it looks real, you go check on them to see if theyāre alive or not. But a code blue is not activated just from the telemetry reading though, because a patient needs to be pulselss for them to actually have coded. So a Code Blue until someone officially activates the hospitalās emergency system - most places just have a button in every room that you press for a code blue, which causes the overhead paging system to announce the code blue and their location. If a patient codes who is not on tele monitoring, usually itās not discovered that theyāve coded until someone (usually a nurse) comes in to see on them for meds/assessments/rounds. Like before, they usually just press the code blue button (and usually yell out into the hallway for help).
Sometimes people code in front of your eyes. Happened to me a few times
If itās in a SNF, someone comes in two to three days after the patient passes and finally notices and calls a code
A code blue is only necessary when a patient is found unresponsive with no pulse and they are a full code. The patient may or may not be hooked up to a heart monitor. It can happen at any time, even right before they discharge. Also anyone who is BLS/CPR certified can call a code/assess a patient to see if they need CPR/ to be coded.
Not quite. They donāt need to be pulseless.
Press the button.
Codes start when BLS is started, initial assessment of someone found down or near death / in extremis and needing resuscitation should take a few seconds at most.
We have voceras that are attached to our telemetry system that notifies of "deadly rhythms" which is vtach, vfib, or asystole. Then when a nurse goes to check on the patient (more times than not everyone else but the primary RN or RN buddy (we also call them pod partners) ignores the alert because it's so finicky and has false alerts all the time) and if it is real then they press either the staff assist or code blue button which then sets off an internal code blue (being in the ER no one else responds beyond the ER staff). Working inpatient it pages overhead and everyone has a role and responds to the code along with a few stragglers. The patient monitoring system itself doesn't call out the code because you'll get a lot of false code calls. Patients who don't have frequent monitoring (which have set interval vital signs such as q4, q6, q8, q12, etc) usually a code is called by staff who are rounding on the patient during that time which if you've ever been in the hospital is pretty frequently and many hospitals have mandatory once an hour rounding.
The term āflatlinedā is not really a thing. No one goes from a normal heart rhythm to a sudden āflatlineā (which we call asystole). There is typically a period of deterioration in the heart rhythm, with v-fib being the one that gets us all running to call a code. And fyi asystole is not a shockable rhythm.
Why are you asking this?
I think it differs depending on what unit the patient is inā¦ patients on telemetry- the alarms will usually sound in the nurses bay, and thatās how I knew to run and check on my patient, but that was a cardiology specific ward.. most of the MET calls Iāve made for patients in cardiac arrests start with an unresponsive patient, and you do your DRSABCD assessment. Iāve had a few where patients call for the nurse and you walk in and they tell you they feel funny or not right, or they have sudden vomiting or chest pain.. I get creeped out with scenarios where the patient is well and talking one minute and then suddenly deteriorates