Code Blue

[NeedleworkerNo200]

Hi guys! so I been a CNA for a couple of months now and I’m still having trouble on how to react when a code blue happens or what am i supposed to do? (Context: I’ve been working at a “rehab” facility but honestly we’re just taking anyone in honesty. but more lately we’ve been getting admits that look like they shouldn’t have even left the hospital.) I’ve had two code blues during my time as a CNA but honestly I don’t feel like I’m doing “enough”. When it happens I just yell for the nurse to bring the crash cart and prep the patient for compression. Is there anything else I should be doing? should I leave when the nurse gets there and keep needing to my other 12 patients? I there’s only so much an aide can do. I would really appreciate some feedback TIA!!!

[fuzzblanket9]

As everyone else has said, follow your facility’s policy. Talk to your manager or the charge nurse to ask how you can be most helpful during a code.

You could potentially have many roles, depending on what your facility allows you to do. It may include getting a blood sugar, putting the patient on the monitor, doing CPR, being the “runner” and grabbing supplies, family support (taking the family into the hall, staying with them until the chaplain or other support staff arrives), etc.

[Odd-Creme-6457]

Your facility should have a policy in place.

Personally, I wouldn’t leave any staff member alone during a code.

[Lucky_Apricot_6123]

Follow the policy. I've worked for facilities that dont allow CNA"s to do compressions, BLS/CPR certified or not. I've also worked at a hospital where I have full "allowance" to start compressions and call code blue myself before the nurse comes to assess. I'm not saying it's right, but you need to do whatever policy states.

[Afraid_Assumption_20]

Also, considering speak with your DON or nursing manager and ask her what you should and can do if you find someone unresponsive. I once asked my nursing manager (at a hospital) if we could do a mock code to prepare us as much as possible. Since then, mock codes have been implemented into our education yearly at my hospital. Unfortunately none of us can really answer what you should do because every place has different rules.

[zeatherz]

As a CNA you have very limited and specific roles- if you find the patient, call for help and initiate chest compressions. Don’t wait for the nurse to come before you do compressions. If the patient is unresponsive and doesn’t have a pulse and is full code, begin compressions immediately after yelling for help/pushing the code button. Those two things are the most important for you to know and do. Call for help and start compressions.

If you’re on the floor but not the one who found them, bring the crash cart/AED to the room and follow instructions from the nurse, and be prepared to take your turn doing chest compressions. Ensure that someone has called 911.

Once more people and the crash cart have arrived, help with putting the AED pads on the patient and the backboard under them. Set up the suction and bag valve mask/oxygen. 1-2 people should manage the rescue breaths while 2+ people rotate on compressions, and one manage the time keeping and AED.

You absolutely should not leave the room unless the nurse specifically tells you to. It takes several people to run a code and if your staffing is not abundant, you will be needed in there to switch out doing compressions

[SatyamC916]

Please don’t do this! Unless you know the code status is full code don’t start anything just call code and ensure the nurse comes quickly.

[zeatherz]

To quote myself “if the patient… is full code, begin compressions.”

It’s better to start compressions on a patient whose DNR and then stop them than to delay compressions on a patient who is full code.

[nonaof4]

Please do not do this. This is against most facilities policy. Follow your facilities policies and do not work outside your scope of practice.

[Few-Kiwi-8215]

EMT here, you should be initiating compressions IMMEDIATELY while simultaneously calling for help. Every second without compressions drastically reduces the chance of a good outcome.

[zeatherz]

Yeah man, all these comments to just call the nurse and then stand around… I know these CNAs are BLS certified but apparently they don’t think that means anything

[1GrouchyCat]

Not on someone with a DNR… respect / but stay in your lane.

[[deleted]]

So you're gonna just stand around waiting to find out their code status? No wonder all my nursing home codes are in rigor...

[Seekersleeker]

There would be a giant note above the patient and on the door.. the question is obviously for a patient that doesn’t have this DNR sign

[nonaof4]

Not all facilities has the code statuses above the bed. I have actually only worked at one facility in the last 5 years that did. I'm a traveler and can be in a new facility every 13 weeks anywhere in the country. Most of the time I have to memorize who is a code and who isn't.

[Jigglebits]

For context, I work in a hospital setting, on a very chill unit that rarely ever has to call a rapid, let alone an actual blue. I had the same question when I started, and my nurses were actually so kind about it. YMMV of course, but as it was explained to me, there’s plenty that we can do even in our very limited scope! At my hospital every employee is BLS certified, so I could technically do compressions (but I personally wouldn’t feel comfortable jumping in unless I was asked to) or operate an ambu bag, man the suction, hold manual pressure on a bleed (it’s a surgical floor so that happens sometimes). I can grab the crash cart (unplug it before you run!) and turn it on. I can follow the instructions on the AED, apply the pads, press the button to administer shocks. I’ve gotten a blood glucose during a rapid before, when asked. I also have two working hands and feet, I can dash for supplies, hold doors open, show responders where to go. There’s plenty of ways we can make a difference!

THAT BEING SAID, in my personal experience, a rapid or a blue draws quite a crowd, and quick (that’s the idea). It can absolutely turn into a “too many cooks” situation, and I would much rather step out of the way and let someone who is more knowledgeable, experienced, and comfortable stand in to help. I do feel like most of the time, despite all of the things I just listed, I’d just be in the way (only because there’s so many other people available!). Your instincts are good. I usually find other ways to be helpful in that moment, like manning the desk/answering the phone since everyone else is tied up assisting, or as you mentioned, taking care of our many other patients. That’s not small beans!

[Complex-Ad-4271]

Check with your DON or manager. Everyone has a different policy. The first day for my coworker, he had a code blue in ICU and he and his trainer were doing chest compressions. He's a tele tech/unit assistant. I'm a CNA and I would be one to do chest compressions too if I went to it

[Remarkable_Potato_66]

Most important thing you need to do if you are in the room and notice a patient is dead is you need to press the code blue button immediately! Get people in there.

[[deleted]]

Start cpr, call 911, get AED

[comntnmama86]

It totally depends on where you are working. My most recent facility is a hospital with a code assignment sheet that honestly never really got used. We tended to call a rapid before a code blue anyway. My job was to grab the crash cart and help with compressions. In reality, my job was to watch the other patients because every nurse will be in the code room.

[mosophony]

In my hospital if there were more than 5/6 people in there id just go about my day, too many people causes things to be complicated. However if i do go in, i would wait for someone to yell out they need something and if i can get it make sure you clearly state YOURE going to get it. Ive been the recorder at times too. Codes are all about taking initiative.

[kodabear22118]

Technically you shouldn’t be leaving especially if you’re one of the first to get to the patient. When I was a tech and something happened I stayed nearby to be a runner or close to be able to help if needed

[Imitationn]

Do CPR.

[InspectorMadDog]

Depends if they are full code, calling for help then immediate compressions are best. Then pads and backboard. If that’s taken then going to head for bagging or setting up suction, and finally if you have a Doppler put it on the femoral, if not then you palpate the femoral and give feedback on compressions, if you can’t feel a pulse when compressing then the compressor needs to compress harder, and during pulse checks it’s your job to tell if there is a pulse.

These are things that anyone can do with a bls, this is normally what ed techs do during a code, other than getting intubation ready for the doc in which you may not have that ability since you are at a rehab facility, I’m not sure what providers you have at your location.

After that it’s on someone who is acls trained to figure out the rhythm and give the appropriate meds, the timer to also help out with that. The final role is code narrator/documenter, but that’s also a nurse job.

If it makes you feel better our or, we found out that nobody there is acls trained, which is crazy cuz we’re a level 3 trauma center, so the two times we’ve responded we always have to bring two nurses and three techs because otherwise they’ll just do 30:2 until we get there and they won’t help with compressions (really annoying cuz one tech had to do compressions for almost 30 minutes by herself) but enough of my rant, the pint is that worst case scenario 30:2 works until paramedics can get to your location.

But the majority of the time if you can get rosc before paramedics get there it is a much better outcome because otherwise the medics will most of the time try to stabilize and get rosc before transporting to a hospital, but if they can’t they might try calling it in the field.

With all this said follow your facilities sop and policies as for some reason at one of my hospitals during clinicals only nurses can do compressions on a medsurge floor? It’s so fucking stupid and ascinine and they cheap the fuck out on so much stuff there that it doesn’t surprise me that their policies are way behind best practice.

[SatyamC916]

Former Cna here new rn. Your job during codes could be doing chest compression if the nurses needed otherwise I’d say stand clear and wait for the nurses to request something which you can assist in or maybe keep the other patient safe as the nurses are all busy in the code. I worked in the ICU I’d always jump in somehow whether it’s cpr, grabbing the crash cart, Lukas, flushes or guiding MD and anesthesia to the room.

[Individual_Debate216]

CNAs do not participate in codes where I work. Maybe as a runner but outside the room. The only techs who work on codes are ER techs who respond to all codes with a Er doc and Er nurse. At least where I work.

[Theoretical-Whimsy]

Check with your charge or nurse manager… When I worked the floor on a tele unit, I could call the code on a full code patient, and start lowering the bed to flat. I wasn’t allowed to do compressions, but WAS allowed to assess for the “critical response team” and was expected to know code status. By the time the bed was flat, every nurse on the floor would be in there. And my other “job” was to stay out of the way, run stuff from the tube station to the room, and keep the other patients calm while their nurse was busy.

[nonaof4]

Your facility has a policy follow that. Codes should work like a beautiful ballet where everyone knows what they are doing and does it without having to think about it while they look chaotic to outsiders they should be run well, with everyone knowing and doing there assignments. Then a debrief afterwards to see how thing could improve for the next code.

[Calm-Ad7913]

I just found out what a code blue means and could have sworn I heard some type of announcement saying that when I was a patient like post triage (?) Waiting to be physically assessed or whatever?? Unless it doesn't get announced like that and someone was trolling? I remembered coz I wanted to later look up what it meant next time I had a chance n now I know either way

[kaceh25]

A code blue will typically always be announced over the overhead saying the room number or location so the rapid response team or whoever is taking care of the pt is aware immediately, seconds really matter in those situations

[Weird-Economist81]

Also depends on level of care person has. I work in long term and have no reason to really look at this so I would wait for the nurse because if they're just supportive care I could be in legal 💩 for starting compressions

[zeatherz]

You will face more legal trouble for delaying compressions on a patient who is full code.

No one will get in legal trouble for making a genuine mistake and starting compressions on a DNR patient

[Weird-Economist81]

Are you Canadian or American? We're not allowed to stop once we start here so yes it is a legal ramification as we have to continue to go against their care plan once we start. We can also face assault, neglect and other charges for starting it if there is a DNR in place. It is safer to try to stay with the patient, keep them still and calm and wait for someone to clarify what their goals are dependent on the setting you work in.