5 Tips on How to Avoid Mistakes During a Code Blue in the OR

Ready for a Code Blue Call in the OR?

Every second counts when a surgical patient experiences cardiac arrest or a similar life-threatening emergency requiring a Code Blue call in the OR. Staying ready for these rare occurrences requires the right mix of training and preparation.

To help team members successfully fulfill their role when a call is made, periop nurse leader Nanette Hamley, BSN, RN, CNOR, led a quality improvement initiative to tackle Code Blue challenges at Orlando Health Jewett Orthopedic Surgery Center in Oakland, FL.

With emergency response a key focus for new nurses orienting to the OR, we asked how she coordinated these improvements with her frontline.

Top 5 Strategies to Avoid Code Blue Mistakes in the OR

Hamley shared her top five strategies to help all OR team members avoid Code Blue mistakes:

1. Know Your Role

“Every team member must be totally comfortable in the individual actions they are responsible for during a Code Blue response, and they should be familiar with other team member’s roles, too,” she said. What’s more, she recommended Code Blue roles be reviewed and redefined as needed to streamline physical movement in the room and capitalize on specialty knowledge for faster response.

2. Be Ready to Make the Actual Code Call

After implementing a new paging system, Hamley and her team then needed to train staff on how to respond when the call was made. “We made it fun with a poster displayed throughout the staff spaces of a person roller skating to the call and instructions for how to make the call. Everyone got such a kick out of the poster -- it stuck with them and improved call compliance.”

3. Help Facilitate Faster Patient Access

Resuscitation equipment and access to the patient requires space. That space must be made as fast as possible following a Code Blue call. To speed this up, Hamley and the team looked at the team members who are typically in the room and then assigned room reconfiguration tasks as follows: 

• Surgical tech keeps the instrument table sterile
• Surgeon removes extraneous equipment
• Anesthesia professional and RN Circulator (and PA or First Assistant if in the room) reposition the patient if needed
• Surgical aide (in response to the page) brings in the stretcher to facilitate repositioning the patient to supine if in the prone position

“One critical change in team coordination we made that happens prior to any prone surgery is for the RN Circulator to remind the surgical aide not to remove the stretcher,” Hamley said.

4. Use a Photo Medication Chart

To make medication response documentation more efficient, while also ensuring correct medication and dosage, Hamley's team created a photo medication chart displayed on the crash cart. “This saves documentation time because you only need to document the time medication was given next to the med photo,” she explained, noting this process saves time so that the team member doesn't have to write down the drug/dose/time each time a medication was given.

5. Be Safety Certified

To ensure fast and correct resuscitation on anyone’s watch, all anesthesia team members must confirm current Advanced Cardiovascular Life Support (ACLS) certification. All perioperative nurses also carry ACLS certification, and every team member must be Basic Life Support (BLS) certified. Additionally, Hamley’s team implemented the Stanford University ACLS Algorithms for Cardiac Arrest to better coordinate applying ACLS protocols specific to patient need.

Want to hear more? Use your Virtual Expo Pass to watch Hamley’s session, Code Blue OR 6: Lessons Learned, and get more details to help your team improve every Code Blue response.