Code blue report form

Patient Safety Committee. CODE BLUE REPORT FORM. Instructions on how to fill up.

WHAT WE WILL TALK ABOUT. Introduction When to fill up Special considerations How to fill up Who will fill up.

WHAT IS CODE BLUE REPORT FORM?. Provides instructions for a coordinated operational response to episodes where a patient experience cardiac and/or respiratory arrest or any other situation where urgent clinical assistance is needed..

WHEN TO FILL UP. This form must be completed during any CODE BLUE drill. Use one (1) form for each resuscitation process.

SPECIAL CONSIDERATION. For "CODE BLUE" cases wherein the patient is already intubated and hooked to MechVent, or have existing contraptions, write "PRE- EXISTING" on the column of TIME of the already existing contraption and the date the contraption was inserted. While for the REMARKS, write the PRESENT status/ settings of the machine/ contraptions. Include the date and time when the status/ settings was assessed..

Write the general information about the patient Indicate the initial assessment of the condition of the patient For initial resuscitation, document the necessary information about the resuscitation process..

PRESENT SETTINGS 08/15/2023 8:00 AM. PRE- EXISTING 08/10/23.

HOW TO FILL UP. Specify all the intervention and medication administered during the resuscitation process. Indicate the Resuscitation Outcome of the resuscitation process..

WHO WILL FILL UP. The Resident on duty will lead the Resuscitation Team Nurses on duty will facilitate the filling out of CODE BLUE REPORT FORM The pronouncement of resuscitation outcome will be the responsibility of the Resident on duty..

THANK YOU.