In this episode, I’ll discuss how patients are less likely to die if a pharmacist response to the code blue call.

Why should Pharmacists respond to code blue calls?

It’s simple.

Patients will die less often. To the tune of 12,880 reduced deaths in 2007, p=0.009 according to:

Bond, C. A. and Raehl, C. L., Clinical Pharmacy Services, Pharmacy Staffing, and Hospital Mortality Rates. Pharmacotherapy 2007, 27: 481–493.

Even without any data I still think you should be there at the codes Pharmacy Nation!

A code is a high-stress situation with rapid decisions being made about medications – why shouldn’t a pharmacist be involved?

You wouldn’t jump from a plane without a parachute despite a lack of evidence that parachutes prevent death from gravitational challenge would you?

Roles and expectations of a pharmacist at a code

Role 1 – Assume responsibility for the provision of pharmacotherapy

– Locate/obtain necessary medications quickly and easily

– Calculate doses, rates, concentrations correctly

– Prepare and label medications appropriately

– Provide IV compatibility information

Role 2 – Actively participate in medical decision making

– Make treatment recommendations

– Determine the cause of deterioration

Role 3 – Anticipate patient and provider needs and prepare in advance to meet those needs

– Be the pessimist in the room and always plan for “what is the worst thing that could go wrong right now?”

Role 4 – Function as a knowledgeable team member

– Make an effort to know the purpose and location of the non-drug contents of the code cart

– Be aware of what is going on around you

Other team members you can expect at the code

– Patient’s nurse

– Critical care nurse

– Respiratory therapist

– Patient care technician

– Physician (hospitalist / intensivist / cardiologist / other)

How to respond

Remain calm! Each code will be a different scenario; be alert and pay attention. You will become more comfortable each time you attend a code.

At my institution, notification will come via the overhead page system and code beeper.

Take stairs when possible to reach the site of the code. The elevator will slow you down too much.

When you enter room/area identify yourself to staff already in attendance.

Make your initial observations

Are chest compressions being performed?

What does the patient look like?

Respiratory distress?

Unresponsive?

Alert?

What other team members are present?

Get to work

If the medication tray has not been removed from the cart, remove it, place it on a flat surface, and open the plastic wrapping.

If the medication tray has been removed already, offer to assume responsibility for the medications.

Identify the physician running the code.

Identify the nurse recording events.

Identify the nurse administering medications.

Stand by the medication tray in sight of the physician running the code.

If possible, be in view of the ECG monitor.

At the start

At the start of the code open and assemble a 1 mg / 10 mL epinephrine syringe.

Obtain 6 NS flushes and prepare them for immediate use.

Attach a needle to a 10 mL syringe.

Locate additional supplies as necessary for requested medications.

Stay focused on the physician running the code.

I’ll continue discussing pharmacist response to code blue calls in the next episode.

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.