TITLE: Medical Emergency (Code Blue) and Evaluation Form

APPLICABLE STANDARDS: EC.4.10 and PC.9.20

REFERENCES:

OBJECTIVE: To adequately evaluate the organization’s preparedness for medical emergencies plans and to maintain staff awareness of their duties in the event of an emergency

PROCEDURE(S):

When is it appropriate to call a Code Blue?

If a patient:

·  Is visibly bleeding

·  Is complaining of chest pains

·  Looks excessively pale

·  Faints

·  Complains of extreme pain

·  Is short of breath or cannot breathe

What information should you say over the intercom for a Code Blue?

During the overhead page, you should say Code Blue and the location of the Code.

·  When a Code Blue is called, medical staff (providers, nurses and health assistants) in the immediate area of the Code should respond immediately

·  All providers and nurses working on the second floor south side will respond to the code area immediately.

·  If necessary an ambulance will be called (@ 911) to transport the patient to an emergency room. If an ambulance is called, a health assistant will wait on the first floor in the lobby to direct the ambulance crew to the site of the Code Blue. The health assistant will hold the elevator for the emergency medical personnel.

Mobile Dental Van

Since medical personnel will not be available on the mobile dental van, 911 should be called for any medical emergency. School nursing personnel, if available, can be consulted to assist with management of an acutely ill person, but this should not delay activation of the EMS system.

Evaluation

Immediately following the resolution of an actual medical emergency or as part of a planned drill or a real Code Blue (Medical Emergency), the Risk Manager or designated personnel shall complete the Medical Emergency Management Evaluation Tool (attached). The Evaluation Tool can be found in the maroon binder located at the nurses station entitled, ‘Emergency Situations, PI/RM Reports and Code Forms’. These forms, once completed, are forwarded to the Risk Management Committee for review at the next monthly meeting. (See policies on the Risk Management Committee and Life Safety Management Plan)

Risk Management Committee Responsibility

1.  Overseeing completion of the Medical Emergency Reports

2.  Schedule tests and establish areas to be tested as part of its annual plan of action. Frequency of drills must be at least 2 times per year.

Risk Manager Responsibility

The Risk Manager is responsible for scheduling and facilitating a random medical emergency drill in collaboration with nursing and clinic wide education.

Required Competencies of all nursing and provider staff

  1. Recognition of acute medical crisis
  2. Proper use/application of medical equipment
  3. Equipment: Oxygen tank, EKG machine, ambubag, ER medication box, Automatic Electronic Defibrillating Device
  4. Adherence to policy/procedure regarding management of acute medical emergencies, especially notification and documentation (see Emergency Management Plan)
  5. Proper CPR with AED procedures.

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SIGNATURE: Dr. Kristine McVea, MD MPH DATE

Medical Director, OneWorld CHC

______

SIGNATURE: Andrea Skolkin, MPA DATE

Executive Director, OneWorld CHC

F:\Policies and Procedures 2007\Environment of Care\Code Blue_Medical Emergency 07-07.doc 7/12/2007 Page 2 of 5

MEDICAL EMERGENCY MANAGEMENT EVALUATION TOOL

FACILITY: ______Date: ______

TYPE OF DRILL/EMERGENCY (Describe):

COMMUNICATIONS Circle One
1. / Was the appropriate CODE reported through the intercom system? / Y / N / N/A
2. / Did all the appropriate staff and individuals hear the CODE/Alarm? / Y / N / N/A
3. / How quickly did the staff respond? ______
ORDERS
4. / Did all staff respond appropriately to the DRILL/EMERGENCY? / Y / N / N/A
5. / Did the staff call 911 in a timely manner / Y / N / N/A
Y / N / N/A
PATIENT, PERSONNEL & VISITOR SAFETY
6. / Did the staff remove unneeded staff, patients and visitors from the area? / Y / N / N/A
7. / Were all patients & visitors escorted to a safe area and calmed? / Y / N / N/A
8. / Did all staff respond correctly and avoid injury? / Y / N / N/A
9. / Did staff maintain the patient’s privacy whenever possible? / Y / N / N/A
EQUIPMENT AND SAFETY FEATURES
10. / Did the staff know where the emergency equipment/supplies located:
·  ER Medication box / Y / N / N/A
·  Oxygen / Y / N / N/A
·  EKG machine / Y / N / N/A
·  Ambu Bags (peds adult) / Y / N / N/A

COMMENTS:

Description of the Event

Please describe the circumstances of Medical Emergency below. Touch on all the actions performed throughout the Medical Emergency.

DESCRIPTION:

STAFF PARTICIPATING IN DRILL/EMERGENCY

Staff Completing Evaluation: ______Date: ______

______Date: ______