What a Nurse Should Do When There’s a Code Blue in the Hospital?

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As a nurse, you might have probably come across the term code blue, during your work. If you’ve never been present during a code blue situation, then you might be wondering what it means or how it relates to your duties and responsibilities. Well, code blue refers to a situation when a patient experiences sudden respiratory or cardiac arrest. If you are attending to a patient and you notice that they are not breathing or their heart has stopped pumping, you should call a code blue right away, as you commence the resuscitation efforts.

What is Code Blue?

In short, a code blue is a hospital emergency code that is called if a patient suffers cardiopulmonary arrest and requires immediate resuscitation. The resuscitation efforts are usually carried out by the facility’s code blue team. However, the nurses on duty should undertake the initial resuscitation efforts. The hospital’s code blue team will then continue with the resuscitation efforts once they arrive on the scene.

Code Blue Team

When there is a code blue in the hospital, every member of the team has a different role to play. As much as healthcare facilities have different code blue team members, most teams will comprise of a team leader, compressor, airway manager, defibrillator manager, crash cart manager, a pharmacist, a recorder, a runner and a recorder. Apart from the medical personnel, a code blue team might also consist of a security officer as well as someone who can offer pastoral services

  • The physician: This is the team leader during a code blue. They direct all the resuscitative efforts, communicate procedures to be undertaken to the other team members, and monitors how the patient is responding. The physician in charge should be a highly experienced medical professional who can effectively observe all the details of the resuscitation procedure. Since most patient rooms are quite small, the physician or the team leader might order the nurses to move some of the furniture temporarily. If it’s a room with two patient beds, then one of the patients might have to be moved to another room temporarily.
  • The compressor: The compressor the first responder on the scene. If you are the first responder on the scene, you should begin the chest compressions immediately. Don’t wait for the compression backboard to arrive. The depth of the compressions should be approximately 5 cm while allowing complete chest recoil after every compression. Also, you should keep the duration and frequency of interruptions in compressions to a minimum, to increase the number of compressions that you can deliver per minute. On average, you should aim for approximately 100 compressions every minute, to increase the chances of successful resuscitation.
  • The airway manager: This is usually the second responder during a code blue. They will bring the necessary emergency equipment such as the airbag and an e-cart. The airway manager will also secure the backboard beneath the patient. Also, the second responder will be constantly switching roles with the first responder in giving chest compressions. On the other hand, the security officers will be helping with crowd control, facilitate the transfer of the patient and ensure the patient’s valuables are secured during the procedure.
  • The recorder: Also known as the scribe, the recorder is tasked with documenting the whole process. This individual will also remind the team leader when it’s time to switch the compressors. They will also communicate with the team leader throughout the procedure regarding the various interventions that have already been applied. Recorders should be individuals who have been involved in previous code blue situations.
  • Pharmacist: Some medications might be required during a code blue in the hospital, and this where the pharmacist comes in. The pharmacist will prepare those medications, calculate infusion rates, and help to prevent or minimize drug incompatibilities. Also, the pharmacist will make sure that the e-cart is stocked properly.
  • The runner: This can be a nurse or anyone who is familiar with the hospital’s layout, especially the locations of the blood bank, the laboratory, the pharmacy and other areas that might be accessed during the code blue. Considering that a code blue is a life and death situation, you need to fetch the supplies from the various areas as fast as you can. And that’s why it’s important to wear the right pair of nursing shoes. As long as you are wearing proper nursing sneakers or nursing clogs, you can rush from one place to the other, without worrying about slipping or sliding.

What to Do During Code Blue

Be active: Whether you’ve been involved in another code blue or you are doing this for the first time, you should be an active participant. After all, you can only enhance your nursing skills in situations like these if you participate. Participating during code blue will give you valuable hands-on experience.

Observe the chain of command: Every code blue situation has a person who is in charge. As a nurse, your job is to support the code blue team and do as you are told. Just because you’ve been involved in other code blue situations doesn’t mean that you should now take matters into your own hands. Respect the chain of command, follow instructions and don’t get in the way of the other team members.

Participate in mock sessions: Most hospitals and other healthcare facilities regularly carry out mock code blue sessions. These mock sessions are designed to acquaint the nurses with the facility’s policies and practices during a code blue. Make sure you participate during those sessions since it’s where you will learn code blue dos and don’ts.

Debrief afterward: After the code blue is over, it’s advisable to talk with the team that was involved and get feedback on what went well as well as the things that you need to improve. Take this feedback positively, as it will help you to enhance your skills and knowledge whenever you encounter such situations.

Code Blue Don’ts

  • Shouting: Yelling or shouting doesn’t help anyone. Instead, it will just create more tension at the code blue scene. Instead, you should remain calm and composed. Remaining calm will help the responders to remain focused throughout the process.
  • Switching roles: If you would like to change roles during a code blue, then you should communicate with the teams involved, to make sure someone replaces you. And if no one is available to take up your place, then you shouldn’t switch roles. As you already know, this is a critical moment for every individual involved, and any mistake can lead to the death of the patient.
  • Leaving when the team arrives: Just because the code blue team has arrived doesn’t mean that you should leave the scene right away. Since you know this patient well, you might have some valuable information that the code blue team might need while attending to the patient.

If the resuscitation was successful, the nurse should transfer the patient to another area for further treatment or stabilization. If the issue arose due to cardiac problems, then the patient should be transferred to the ICU or a cardiac catheterization lab, in case there is one in the facility. The defibrillator or should remain attached to the patient so that you can continuously monitor their cardiac rhythm when they are being transferred. The team should also be accompanied by the airway manager. All procedures thereafter should follow the facility’s code blue policies.

Closing Remarks

If you are a nurse, experiencing code blue for the first time can be a terrifying and unforgettable experience in your nursing career, since it happens fast and unexpectedly. But after going through it, you will be more skilled and confident to handle such situations in the future. Also, most healthcare facilities offer code blue mock-up sessions, to acquaint their nurses on what to expect during such situations. Therefore, make sure you attend all those mock-up sessions whenever you are available.

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About the author


Hi, I’m Brian Bradshaw. I’m a super duper mega hiking enthusiast, with a love for everything that has to do with outdoors, hiking, gear, footwear and more.

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