Code Blue: Reviewing Resuscitation Practice

Nursing Professionals and the Resuscitation Process

Discuss about the Media Annotation Review Of Code Blue.

Code Blue is the term used by medical institutions across the globe for indicating that a patient has suffered a cardiopulmonary arrest and is in immediate need of resuscitation. The resuscitation is carried out by the ‘code team’ present at the healthcare unit. However, the initial efforts for resuscitation are to be carried out by the nurses on duty. It is therefore crucial for nursing professionals to have a thorough knowledge regarding resuscitation process and the essential skills in this regard. Communication between the nurse and the code team is also of crucial importance to ensure that the desired patient outcomes are achieved. An amalgamation of technical and non-technical skills ensures that nurses deliver optimal quality care through safe approaches in resuscitation. The present paper is a media annotation that is based on the review of a video titled “Code Blue”. The video is on an arrest scenario associated with resuscitation, and the analysis is done for quality of identified practice and performance. Preference to Australian Resuscitation council guidelines and other scholarly papers is done for identifying the strengths and weaknesses of the performance. Recommendations for practice change are outlined thereafter.

A deep insight into the video brings into notice that after the nurse entered the patient’s room and understood the need of emergency care to the provided she called out to the fellow nurse for contacting the Code Blue. It would have been desirable if she had pressed the emergency button instead. According to Massey et al., (2014) medical emergency situations are to be addressed by pressing the emergency button as an acute illness might pose a threat to the patient’s life. Any response in the emergency situation would depend strongly on the situation, the condition of the patient and the availability of resources. As highlighted by Ebert et al., (2017) the role of the health professionals acting as the first responders is critical as resuscitation efforts are to be started at the earliest. The second issue that arose was that the nurses did not consider assessing the airway of the patient. As per the Australian Resuscitation Council guidelines (2016) the initial steps of resuscitation involves the initial steps of DRS ABCD (dangers, responsiveness, send, airway, breathing, CPR, defibrillation). Assessment of the patient’s airway along with unresponsiveness is required for identification of the need of resuscitation. In case of an unconscious patient, care of airway takes precedence over any poor outcomes (Maconochie et aal., 2015). Further into the video, the nurses did not take the pillow out for enabling the patient in a proper position. In addition, the nurses checked the breathing pattern of the patient from distant height. Patients who are breathing in an abnormal manner or are unresponsive require assessment of breathing (Piegeler et al., 2016). Australian Resuscitation Council Guidelines (2016) outline that while assessing the breathing pattern of the patient needing resuscitation, professionals must look for movement of the lower chest or upper abdomen, listen for the escape of air from the mouth and nose, and feel for the movement of air at the nose and mouth. This process of breathing assessment was not followed by the nurse as the height of the bed was too low to carry out the assessment in an appropriate manner.

Strengths and Weaknesses of Resuscitation Practice

Coming to the section of the video where compressions were provided to the patient, a number of key weaknesses were identified. Firstly, the nurse stood and stressed on the back of the patient while giving compressions. The compressions were also not rhythmic. The Code captain asked to stop the compressions for a second for checking the heart rhythm of the patient.  Further, the nurses did not count appropriately for understanding the point of time in which airway management was required. Moreover, no professional engaged in carrying out the compressions, and the same had to be stopped while delivering the shock to the patient. A look into the Australian Resuscitation Council guidelines (2016) reveals that all professionals must carry out chest compressions for patients with minimal interruptions. The professional delivering the compression must do so in a rhythmic manner with the focus on equal time for compression and relaxation. Further, attention is to be given to the aspect that the chest of the patient is completely recoiled after every compression. The professional is also supposed to avoid using thumps or rocking back and forth while compressing. In this regard, the depth of compression delivered is to be analyzed which was in appropriate. As per the Australian Resuscitation Council guidelines (2016), the lower portion of the sternum must be depressed to at least one third of the depth of the chest in case of each compression. This is equal to more than 5 cm in adults. Idris et al., (2015) placed focus on the utmost need of sufficient compression depth. Inadequacy in compression depth has a strong relation with poor patient outcomes (Perkins et al., 2015).

The Code Captain was found to prescribe medication that is epinephrine, prior to checking for any allergic reactions that the patient might have had. There was a possibility that the condition of the patient would have deteriorated if the patient was allergic to epinephrine. According to Belkin et al., (2017) epinephrine is a strong adrenaline medication that acts a cardiac stimulant. The adverse effects of epinephrine include hypertension, palpitation, tremor, respiratory difficulty. Another concern regarding the practice of the Code Captain was that he requested for a briefing of the situation much later into the care process of the patient. It would have been appropriate if the nurse had engaged in a proper handover at the initial stage in a proactive manner. The need of safe and timely handover has been mentioned by a number of researchers (Barry et al., 2018). Continuity of information is crucial for safety of patients. Relevant and sufficient information is to be exchanged between care professionals at the initial stage when teams work in collaboration so that approaches taken fit the needs of the patient.

Improvement Areas in Resuscitation Practice

In terms of patient assessment, some inappropriate practices were highlighted. Firstly, there nurses did not consider carrying out an assessment of the patient to record the oxygen saturation, blood pressure, pulse and blood glucose level. Oxygen saturation was checked at a later stage and blood pressure was recorded after recording blood glucose level which was a poor practice. The initial assessment of the vital signs of the patient prior to resuscitation is elementary for understanding the exact needs of the patient and the consecutive improvement in the condition of the patient (Monsieurs et al., 2015). The initial recording of the vital signs requires a systematic and rapid approach. A systematic approach is needed for increasing the speed of the resuscitation process as a demonstration of good clinical judgment.

Absence of delegation of roles is crucial weakness of the practice as evident from the video. The professionals did not have clarity in understanding the exact roles they had to fulfill in a code blue scenario. They also lacked knowledge of the tasks they had to carry out. It is also worth mentioning that the professionals did not have a proactive approach in taking part in the process as they did not decide among themselves about giving compressions in queue. A poor non-technical skill was evident from the fact that the nurse demonstrated indistinct speaking. From the research of Porter et al., (2013), effective resuscitation team is one where there is a delegation of roles among the members and there is concise leadership. Members of such teams, more importantly the nurses must have a clear knowledge of the tasks that are to be performed independently for achieving a common goal. Important clinical decisions can only be taken when there is a proactive approach demonstrated by the team members (Ford et al., 2016).

There was room for improvement regarding the debriefing at the end of the code. The code captain briefly appreciated the efforts of the team members without any detailed discussion of the same. The records were noted down and the scribe requested to members of the team to sign the document before any discussion among the professionals was done regarding the outcome. Research suggests that debriefing is an effective strategy for improving the quality of cardiopulmonary resuscitation (Couper & Perkins, 2013). Debriefing can take be in two different formats. Hot briefing involves individuals providing debriefing immediately after the code. Cold debriefing involves individuals providing debriefing at later stage after the completion of the code. Objective performance data is to be discussed in such debriefing (Risaliti et al., 2018).

Recommendations for Practice Change

At this juncture of the analysis it would be beneficial to highlight the strengths of the practice as evident from the video. The code captain demonstrated professionalism as an assessment of the ECG rhythm was done prior to the delivery of the shock. As highlighted by Guana et al., (2014) the chances of survival of the patient after resuscitation depends on a number of factors including early ECG assessment. Reliable rhythm analysis prior to compression is of great value (Australian Resuscitation Council Guidelines 2016). The nurse announced saying all clear before delivering the shock. This reflects responsible and professional behavior and technical skills since delivery of shock to patients entails minimal interference (Soholm et al., 2014). The code captain had requested the scribe to inform at the end of two minutes after delivery of the shock and the scribe showed professionalism in abiding by this order. The scribe checked the time accurately after the code was complete and requested the nurses to verify the records before signing. The nurse acknowledged that the strip of sinus rhythm was printed with ten minutes time difference which she ensured to mention in the code blue record. Accurate information documentation is critical for successive care plan in a care environment. The need of proper documentation in resuscitation process has been mentioned by (Karam et al., 2018).

From the video it is noted that the social worker had a positive approach to inform the family members of the patient. As per the Australian Resuscitation Council guidelines (2016), family members of patients undergoing resuscitation are to be given the option of being present at the time of resuscitation. Study by O’Connell et al., (2017) argue that presence of family members at the time of recitation, if possible, leads to improved measures of positive emotional and health outcomes, and coping. Some other strengths of the practice were that the head rail was removed for giving breaths to the patient. The rail would have acted a barrier in this process.

A critical analysis of the video brings into limelight that certain practice of the professionals seemed to be inappropriate though the outcomes of the same were desirable. Firstly, the scribe nurse responsible for documenting the code was not efficient enough as processes that were being undertaken on more than one instance. On one instance she clarified the medication name that the nurse had administered to the patient. Secondly, the scribe confirmed whether it was cardioversion or defibrillation that was given. However, it is worth mentioning that it was a good practice of clarifying concerns in order to work for the safety of the patient. Since the scribe clarified the doubts raised, there was minimization of risks associated with wrong documentation (Cooper et al., 2016). Further, though there was no proper seal while undertaking airway management, the fact that the nurse asked for help and assistance reflected high level of communication. Communication and team work has been praised for enabling care professionals to act in the best interest of the patients (Calder et al., 2017).

It is recommended that better personal resource skills and technical skills would have improved the performance of the team members. It would have been appropriate if the nurses had more situational awareness prior to the resuscitation process (McLaughlin et al., 2017). Further, since many activities are to be carried out in a simultaneous manner in such a process it is pivotal that relevant information is communicated at the initial stage (Martin & Ciurzynski, 2015). It is also recommended that the supervisor in the code blue team is accountable for the actions and participants in providing feedback (Calder et al., 2016). Nurses taking part in code blue are to accept leadership. Delegate appropriately, show assertiveness, and demonstrate credibility (Clarke et al., 2016). Coordination among the members was more in need in case of the present scenario, along with open communication.

Coming to the end of the paper it can be concluded that the video presents some notable weaknesses and strengths of the practice aiming to address code blue situation. The analysis has been done on the basis of existing literature and guidelines of Australian Resuscitation Council. The annotation was a good opportunity for professional development in nursing practice. Key insights from the annotation would be applied in future in relevant scenarios.

References

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