05.02 Calling for RRT, Code Blue

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Included In This Lesson

Outline

Overview

When patients deteriorate, we must know when to call a rapid response versus a code blue. Every hospital has different criteria and protocols regarding a patient’s condition and when a rapid response needs to be activated or a code blue should be called.

Nursing Points

General

  1. Rapid Response Team
    1. A team of health care professionals
    2. Respond to a patient’s deteriorating situation
    3. Team will assess the patient and prevent a code blue
    4. Determines what interventions should be taken
  2. Criteria for calling a rapid response
    1. Depends on facility
      1. Hypoxia
      2. Hypotension/Hypertensive
      3. Hypoglycemic/Hyperglycemic
      4. Altered LOC
      5. Falls
      6. Bradycardia/Tachycardia
      7. Arrhythmias- SVT/AFib with RVR
  3. Criteria for calling a code blue
    1. Pulseless patient
    2. Apneic patient
    3. Dead Patient
    4. Same healthcare professionals that respond to a RRT respond to a code
    5. Revive patient and transfer to ICU if not already in ICU

Transcript

Hey guys, in this lesson we’re going to talk about the difference between calling a rapid response team or a code blue. So let’s go ahead and get started. So a rapid response team or a code blue, basically, we can activate these codes when patients deteriorate and we need help. So we either need to call a rapid response or we need to call a code blue, hospitals have different criteria and protocols for calling a rapid response or a code. So get to know the hospital that you work at and find out what their criteria is and what criteria the patient should meet before you can call a rapid response. Code blue is pretty simple. So let’s talk about all those. What is a rapid response team? Basically, this all started actually about maybe 15 years ago, before we would just wait until the patient was coding and we would call a code, and then they started doing this rapid response stuff.

So it is a team of healthcare professionals. It’s usually an ICU registered nurse, a respiratory therapist, a doctor, and a pharmacist. And so they respond to a rapid response, So they quickly respond to a deteriorating patient. So when you call a rapid response, basically what it means is that there’s something wrong with your patient that you can’t fix it and you need help now before that patient codes and dies. So these people show up and they assess the patient and they try to figure out what’s going on with them so that they can try to prevent a code from happening, that’s their main job. They assess the patient and prevent an actual code and they determine what interventions should be taken. So if the patient basically needs to be on a BiPAP or they need to be intubated or they need something for their blood pressure to go up or down, or the heart rate.

And because there’s a physician usually right there and a pharmacist, they can get all the medications right then and right there. So it’s an easy way to fix the patient as soon as possible. So how do you know when you should call a rapid response? Let’s talk about that now. This depends on the facilities, at my facility, these are some of the criteria that we have set that they feel that nurses should call a rapid response. So if you have a patient who has some hypoxic or dyspneic and their SATs are 85% and you put two liters on them and their SATs are not getting any better, there’s no improvement, they are still severely short of breath. That’s when you call a rapid response team. Now, if you have a patient who’s not on oxygen and oxygen saturation is 88%. Well, you don’t go calling a rapid response, go put some oxygen on them after you get an order of course.

But the point is you’ve done something, they’re not getting any better and you need some help. If they are very, very hypotensive, like maybe in the 70s systolic and they’re symptomatic or same with hypertension, you’ve got a blood pressure in the two hundreds. You’ve tried to do something and give them some meds and it’s not getting any better. Well, you’re going to call a rapid response team because you want to prevent a stroke from happening. If they are hypo or hyperglycemic, at my or my hospital I think that if the blood sugar is less than 70 and they are symptomatic, you’re supposed to call a rapid response again because you know that it gets you that the help that you need very quickly to be able to give that D 50. Any falls at my hospital are part of the criteria, if a patient falls, they want you to call a rapid response so that the rapid response team can go assess the patient and find out if something is wrong or if they’ve had any major injuries. Any altered level of consciousness if something is wrong again and all of a sudden they’re confused and they were not and you don’t know what it is. Hey, call a rapid response. Another one is uncontrolled arrhythmias. If they keep going into V tach and they don’t stop or if they keep having these very long pauses and they are symptomatic, call a rapid response, get that help in there. Because when you do have that ICU RN in there, the respiratory therapist, the doctor, it gets the ball moving a lot quicker. So if the patient needs to be transferred to ICU, it can happen a lot quicker since they’re there.

So criteria for calling a code blue, well this is kind of pretty self explanatory. If you have a patient that doesn’t have a pulse, they’re apneic, they’re dead call code. For the most part they are called code blues. At my hospital we call it a code 44. And so whenever you hear a code 44 paged overhead, you know that it’s a code blue and someone’s dying in, you better be prepared to go in there and start CPR. And again, usually the same people that are on the rapid response team come to the code blue as well. Their main job is to come in revive the patient and then transfer them to ICU if they’re not already in an ICU. So having extra hands is okay to save a life which is why they come.

If your patient’s blood pressure is in the 70s you call a rapid response. Call a code blue if your patient does not have a blood pressure and does not have a pulse and is not breathing, then you call a code blue. Okay, so to recap in this little short lesson, the difference between a rapid response and a code blue is a rapid response is your patient is circling the drain. They are deteriorating, they’re going to die and we got to do something. Okay, we have got to do something before they die, a code blue, they’re there. Now we’ve got to bring them back, we’ve got to do some CPR because they have died on us and we got to bring them back. That is the difference between a rapid response and a code blue. Now again, the criteria for activating it, code blue is pretty self-explanatory. They don’t have the pulse, they don’t have blood pressure. They’re not breathing call code blue. But criteria for rapid response, again, hypoxic altered level of consciousness, hypo or hypertension, hypo or hyperglycemia. Again, it just depends on your facility’s criteria. And again, never hesitate to call one. If you think something is wrong and you just don’t know what it is, this is where, again, trust your gut. Okay, I know we just had that lesson and if you haven’t heard it, go back and listen to it. Trust your gut. If you think something is wrong and it doesn’t meet any of the criteria, that’s okay, call it. You really don’t know, all you’re trying to do is save a life. Again, it’s better to be safe than sorry. If you think you go in a room and the patient’s not breathing and you can’t feel a pulse, that’s fine. Call a code again. It’s better safe than sorry. Never hesitate to call one. So I hope this little lesson has helped you guys and I hope that it helps you understand the difference between a rapid response and the code blue and the criteria as to when to call either one of those. Now, make sure that you guys go out and be your best selves today. And as always, happy nursing.