What follows the chaos of a code blue event, the acquisition and handling of the code blue records, is nearly as important as the management of the event itself. The patient record that is generated during a code blue has three critical functions:

  1. First, and foremost, the record is not only a real-time patient management aid during the event but serves as a road map for post-event care.
  2. Second, the data collected serves as a rich source for directing quality improvement efforts.
  3. Thirdly, the record, if acquired accurately, is the single best picture for reconstructing the event if risk management issues arise.

As a result, it is imperative that the record be the as accurate and complete as possible. It must be immediately available to the providers at all stages of patient care. Because the record provides vital reporting data for the organization, it is essential to eliminate lost records, avoiding transcription errors from paper to system databases, and ease archiving efforts and information retrieval.

To this end, the recorder should not be distracted during the acquisition of the code blue data. Other tasks, such as tracking timed events, stopwatches, or ‘clock watching’ are common distractions. In addition, an efficient code blue recording ‘instrument’ – be it paper or a desk top electronic system should be:

  • a completely mobile device – code blues do not always happen in dedicated patient spaces
  • intuitive in its function – requiring little if any training to for the recorder to stay facile with its use
  • capable of rapid data acquisition
  • have seamless, secure upload to both the patient EMR as well as the organizational data repository

Real Time Patient Management Tool

A valuable code blue documentation system and record would not only provide fast, efficient, complete, and accurate acquisition of data for the patient record, but, if possible, assist providers in making management decisions.

Post event, if return of circulation (ROSC) is achieved, the patient is frequently transferred to higher level of care, often on a ventilator. An integral part of real time patient management is making the code blue record immediately available to the transition team at the end of the code.

The team must understand what caused the cardiac arrest, and how the patient was managed. Without a record of the drugs administered or some assessment of the 6h’s (hypovolemia, hypoxia, hydrogen ion, hyperkalemia, hypokalemia, and hypothermia) and 6t’s (toxins, tamponade, tension pneumothorax, thrombosis: myocardial infarction, thrombosis: pulmonary embolism, and trauma), intensive care may be unable to provide the post resuscitation care that patient needs for long-term survival.

Unfortunately, in addition to poor timing of critical interventions, the records often contain inaccuracies, are grossly incomplete, and replete with errors. Most disturbing, paper code blue records are frequently lost on the way to the ICU and so never make their way into the patient’s record. As a result of the paper handling process in many healthcare systems, code blue records are frequently not available for upload into the patient’s medical record until days after the event.

RevitalPro, a new code blue documentation tool developed by Format Health in Seattle does just that. The system, virtually effortlessly, allows rapid capture of management decisions and procedures in real time and provides safety alerts and practice guideline prompts to the health care providers. At present, it appears to be the leading code blue data acquisition system available.

Optimizing the cardiac arrest recording process – the paper record or electronic recording system –  to work in parallel with the hospital’s code blue protocol should improve performance. By focusing on creating an accurately time stamped record of management decisions with fewer distractions of data elements details which can be filled in later (such as patient conscious at onset, blood pressure at onset, etc), errors can be minimized.

Finally, keeping the recording provider familiar with the paper record or a complicated electronic record keeping system is difficult, but critical for generating a high quality code blue record as well as delivering high quality patient care.

A record-keeping software (such as RevitalPro: Code Blue) can be used to produce a record more quickly and efficiently. Software options such as RevitalPro provide the benefit of a typed, legible record which can be seamlessly upload to the EMR – thus eliminating the the problem of transcribing a patient record from an illegible handwritten paper record.

RevitalPro: Code Blue provides a solution to many of the problems outlined above as it has  built-in timers to help track dosage and compressions, safety alerts that assist providers adherence to published guidelines, and immediate, seamless, secure upload of the final document into the EMR. An article from the Journal of Emergency Medicine recounts a study in which RevitalPro reduced omission errors by 28% and redundant entries by 36% as compared to paper recorders.

Quality Improvement

Code blue events frequently leave the involved staff shaken and unsure of their performance. Debriefing has become an important practice for both improving staff response and overcoming staff apprehension toward code blue events. Discussing both team performance and individual roles with other responders can both reassure staff members and improve performance.

The record generate by RevitalPro provides an excellent tool for post code blue debrief.

Often, practice/rehearsal is what improves code response. Some institutions have code blue simulations available to improve performance. Participating in mock codes is ideal, because the simulations can be oriented to an individual hospital’s policies. Mock events build confidence in potential code team members and encourage them to get involved. Furthermore, practice and debriefing efforts can improve timing, and, thus, patient care efforts. The RevitalPro system is also an excellent tool to use during training/practice sessions (mock codes) to highlight what care was delivered well and what care might need improvement.

Risk Management

At first glance, an accurate code blue recording systems seems to primarily serve a risk reduction tool. It is that for sure, however, it is important not to loose site of the first two critical functions of an accurate code blue record: patient care and quality improvement.

Risk reduction was the genesis for the development of the RevitalPro system. It was through an unfortunate series of events that the whole problem of inadequacy of code blue records and the poor quality of data was recognized.

Upon further exploration, this problem was found to be a universal issue across most healthcare organizations large and small.  The code blue work flow process can certainly be improved in most healthcare organization.  However until the problem of accurate rapid data acquisition and seamless secure handling of data so that it can be immediately uploaded into the medical record is solved, the care of patients during cardiac arrests will still miss the mark. The RevitalPro system seems to solve many of the glaring problems that face acquisition and handling of patient care information during code blue events.

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