In this episode, I’ll discuss 3 points to keep in mind when preparing your pharmacy department’s code response plan:

1. Ensure that someone responds when expected.

2. Don’t let the perfect stand in the way of the good.

3. Use your response plan to facilitate training residents and new responders.

Ensure that someone responds when expected

To ensure that a pharmacist responds, I’ve found that every available pharmacist who is trained should go to the code when it is called. Assigning one pharmacist to respond to a given area isn’t practical since they might be unavailable when the code is called due to being with a patient, at another emergency, in a meeting, etc… By having everyone respond initially, the chances of no one responding are diminished.

When more than one pharmacist arrives at the same emergency, they can make a decision on the spot about who will remain and who will return to their previous task. It only takes a few moments out of everyone’s day to go to an emergency, decide who will stay, and return to the previous task.

The decision of who stays and who goes can be made based on any number of criteria such as:

1. Who needs more experience with emergency response?

2. Whose unit is the code on?

3. Whose shift is about to end?

In general, I prefer that the pharmacist that stays is the one who has the most experience working with the clinical team on the unit the code was called on, followed by the pharmacist who needs more code experience.

Occassionally, a code has very high pharmacotherapy needs, and more than one pharmacist is needed to acquire, prepare and dispense the necessary medications. In this case when multiple pharmacists respond, more than one will remain at the code to assist.

Don’t let the perfect stand in the way of the good

When your department is starting to respond to codes, there will be a period of time between zero pharmacist response and 24/7 pharmacist response to codes. Depending on your local, state, and federal regulations, administrators may see this as a potential liability. This is because the hospital may be judged as providing two different standards of care – one on the Monday thru Friday dayshift when a pharmacist responds and another on evenings/weekends when there is no response.

The important thing is to not let the perfect get in the way of the good. Try to find other examples in your institution where the level of care is different based on the shift. Then come up with a plan to work towards the goal of 24/7 response. You may have to use some creative solutions such as waiting until you can provide 24/7 response to list a pharmacist as an “official” member of the code team.

Data from 2007 shows that when pharmacists are part of the code team, patient mortality is reduced.

Use your response plan to facilitate training residents and new responders

At any given time you may have pharmacists, residents, and pharmacy students who would like to gain experience responding to codes. This can pose a challenge given the limited capacity of most hospital rooms to accommodate additional staff. You’ll need to strike a balance between having too many pharmacists in the room and providing the training and experience each person needs.

I like to have one experienced pharmacist and one training pharmacist or resident in the room for each code. If the space in the room allows, additional training pharmacists, residents, or students may come in the room. There is not usually time to explain everything that is going on to residents and students during a code. In addition, crosstalk should be kept to a minimum so the code team can concentrate on the task at hand. Because of this, it is important to immediately hold a post-code debrief between pharmacists, residents, and students after the code so that the cycle of learning can be completed.

If you are interested in how to respond to code blue calls, you can download a pdf of my 6 Tips for Pharmacists Who Respond to Code Blue Calls in my free critical care pharmacy download area (it’s download #16):

If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.

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