CODE BLUE – Being a Nurse, You Need to Know It

As Wikipedia says - "Code Blue is generally used to indicate
a patient requiring resuscitation or in need of immediate
medical attention, most often as the result of
a respiratory arrest or cardiac arrest"

No matter, if you are an experienced nursing professional or a newbie, these two words are feared by both and if it is your first time, definitely it will be an experience of ultimate panicking. Surprisingly, it will make you feel as if you are unable to recall everything you have ever learned in your nursing education. Well, that’s Normal!

Sometimes, you may think that you are a terrible nurse when such things happen, don’t worry, it has been experienced by every nurse at some point in their nursing career and if anyone says it never happened, believe us – it’s a lie.

Here’s a story of a RN Daphne Neuhaus in her own words as published in the blog of NCLEXmastery.com - 

"I will never forget my first code blue.

I went back to check on my patient when I heard her continuous pulse ox start beeping like crazy. It said 60% and she had become unresponsive. A Code Blue was called, but before the code team arrived, we needed to put a board under the patient, remove the head of the bed and immediately start compressions and start bagging her.

I was white as a sheet and thankfully had another nurse on with me that kept things calm. I remember the first set of compressions I did and felt the patient’s ribs crack. The team arrived, which is about 10 people.I alternated with a male nursing assistant doing chest compressions…it is like an insane workout. I have watched multiple nurses have to straddle the patient literally to get enough force. We intubated the patient, but we never could get a heart rhythm or get her oxygen levels to come up.About this time, we reached her family and they said to make her a DNR. She unfortunately had thrown a massive pulmonary embolism and she died.

Each time got a bit easier and eventually I became the "calmer" of the other newer nurses, but I was still as terrified as anyone was. You, as well, will become that person as your career progresses."

To help first timers cope up with Code Blue situation, here is some advice from Daphne Neuhaus –

• Give about 10 seconds to prepare yourself. If you panic, you are of no help. Call a Code Blue as per the protocol set by your healthcare facility and if family members are close, ask them to leave the room.
• Put the patient on a flat position and if there is no pulse, start compressions and put on the ambu bag to start breaths with the help of a nursing assistant or a fellow nurse. Check the rhythm of the heart and access to IV. With a bit of luck, the Code Team would arrive by this time and will take over; however, you still need to be in the middle of it.
• More the number of times you face such situations, it will get easier for you to handle the primary stage. No matter how many times you did it, you will always feel terrified in first few moments. 

Code Blue is a situation where your skills and practical experience helps to save a life. To get hands-on experience of such situations, INSCOL provides simulation-based training workshops for nurses in Airway Management, ECG, Cardiovascular Assessment and more. To know more about the workshops, visit http://www.inscol.com/india/cce. 

Nursing Education: Human Factors and Patient Safety

Most of the nurses may surely have heard the term ‘human factors’ in their study period or while practice. However, another fact is that they do not really understand which kind of detrimental effects it can put in their practical work as well as to their patients.

As a whole, healthcare professionals operate within settings that include many physical systems such as- colleagues or team members, equipment, science and the technology itself. It’s amazing how healthcare settings are under the constant revolution of changes and advancement. However, along with this revolution there is always a precaution to be taken. For instance, the presence of such many physical settings leads to many adverse consequences of setups that affect the patient as well. 

As far as the interaction of humans with all these settings is concerned and how this interaction affects the safety of the patients is concerned, this study is segregated as a unique discipline known as the ‘study of human factors’. Nurses shall be acquainted with the details of human factors that may affect the procedure of their healthcare towards the patient. 

It’s been very rare that a patient might get affected by the settings around him/her just because of one person. Nevertheless, in case a patient has undergone an inadvertent, an unintentional harm, the blame is eventually put on a single person. However, the study of human factors in nursing implies that humans shall not be held responsible for the errors occurring due to usage of technology. After all, if the user of a machine commits a mistake, this is primarily because of some faulty design law of the machine itself. 

For example, a nurse is taking care of a cancer patient who requires radiation therapy. The patient’s treatment procedure is fed to the machine delivering the radiation. However, when the error message is displayed on the screen of the machine that ends up being not at all informative. In such case, the physicist who fed the procedure in the machine would think that everything is perfectly fine with the treatment. However, in fact, the machine is fed only with half of the procedure. Now, the cancer patient can be severely burnt. Is it the fault of the physicist? 

Well, from the point of view of human factors, human is a creature that is fallible. No matter how highly qualified or trained you are, mistake happens and to err is human. Maybe, we work in settings that make us prone to commit mistakes, which are unintentional in the first place, but the matter that bothers us is that nurses shall be equipped with the skills of minimum possible errors occurring due to the colleagues, team members, tools, interfaces, devices and technology. After all, all of these are part of their job. 

These days, there are courses such as 'Human Factors in Nurses', which aim to make nurses practice in a simulation based workshop which introduces the varying interactions between all the physical settings to them. It’s an initiative to trigger the psychological quotient of the nurses and make them intuitive and easy at technology, machines and procedures. To know more in details about the courses, please visit http://www.inscol.com/india/cce.