Reduce Stress in Code Blue Events With Electronic Code Blue Documentation

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What follows the chaos of a Code Blue event, the acquisition and handling of the Code Blue records, is nearly as important as managing the event itself. The patient record that is generated during a Code Blue has three critical functions:

  1. First and foremost, the record is not only a real-time patient management aid during the event but serves as a road map for post-event care.
  2. Second, the data collected serves as a rich source for directing quality improvement efforts.
  3. Thirdly, if acquired accurately, the record is the single best picture for reconstructing the event if risk management issues arise.

As a result, the record must be as accurate and complete as possible. It must be immediately available to the providers at all stages of patient care. Because the record provides vital reporting data for the organization, it is essential to eliminate lost records, avoiding transcription errors from paper to system databases, and ease archiving efforts and information retrieval. According to Emergency Medicine Journal¹, electronic documentation of Code Blue events captured 24% more critical information during a simulated medical emergency without loss in data quality. 

 An efficient Code Blue recording ‘instrument’ – be it paper or an electronic desktop system should be:

  • an utterly mobile device – Code Blues do not always happen in dedicated patient spaces
  • intuitive in its function – requiring little if any training to for the recorder to stay facile with its use
  • capable of rapid data acquisition
  • have seamless, secure upload to both the patient EMR as well as the organizational data repository

Real-Time Patient Management Tool

A valuable Code Blue documentation system and record would not only provide fast, efficient, complete, and accurate acquisition of data for the patient record, but, if possible, assist providers in making management decisions.

Unfortunately, in addition to poor timing of critical interventions, the records often contain inaccuracies, are grossly incomplete, and replete with errors. Most disturbing, paper code blue records are frequently lost on the way to the ICU and never make their way into the patient’s record. As a result of the paper handling process in many healthcare systems, code blue records are frequently unavailable for upload into the patient’s medical record until days after the event.

RevivePro, a new tablet-based Code Blue documentation tool, does just that. The system, virtually effortlessly, allows rapid capture of management decisions and procedures in real-time and provides safety alerts and practice guideline prompts to the health care providers. At present, it appears to be the leading code blue data acquisition system available. 

Optimizing the cardiac arrest recording process – the paper record or electronic recording system – to work in parallel with the hospital’s Code Blue protocol should improve performance. By focusing on creating an accurately time-stamped record of management decisions with fewer distractions of data elements details which can be filled in later (such as patient conscious at onset, blood pressure at onset, etc.), errors can be minimized.

Finally, keeping the recording provider familiar with the paper record or a complicated electronic record-keeping system is challenging but critical for generating a high-quality Code Blue record and delivering high-quality patient care.

A record-keeping software, such as RevivePro, can be used to produce a record more quickly and efficiently. Software options like RevivePro provide the benefit of a typed, legible record which can be seamlessly uploaded to the EMR – thus eliminating the problem of transcribing a patient record from an illegible handwritten paper record.

RevivePro provides a solution to many of the problems outlined above. It has built-in timers to help track dosage and compressions, safety alerts that assist providers in adherence to published guidelines, and direct, seamless, secure upload of the final document into the EMR. An article from the Journal of Emergency Medicine¹ found that RevivePro reduced omission errors by 28% and redundant entries by 36% compared to paper recorders.

Quality Improvement

Code Blue events frequently leave the involved staff shaken and unsure of their performance. Debriefing has become an essential practice for improving staff response and overcoming staff apprehension toward Code Blue events. Discussing both team performance and individual roles with other responders can both reassure staff members and improve performance.

The record generated by RevivePro provides an excellent tool for post Code Blue debrief.

Often, practice/rehearsal is what improves code response. Some institutions have code blue simulations available to improve performance. Participating in mock codes is ideal because the simulations can be oriented to an individual hospital’s policies. Mock events build confidence in potential code team members and encourage them to get involved. Furthermore, practice and debriefing efforts can improve timing and, thus, patient care efforts. The RevivePro system is also an excellent tool to use during training/practice sessions (mock codes) to highlight what care was delivered well and what care might need improvement.

Risk Management

At first glance, an accurate Code Blue recording system seems to serve as a risk reduction tool primarily. Indeed, it is essential not to lose sight of a precise code blue record’s first two critical functions: patient care and quality improvement.

Risk reduction was the genesis for the development of the RevivePro system. Through an unfortunate series of events, the problem of inadequacy of Code Blue records and the poor quality of data was recognized.

Upon further exploration, this problem was a universal issue across most healthcare organizations, large and small. The Code Blue workflow process can undoubtedly be improved in most healthcare organizations. However, until the problem of accurate, rapid data acquisition and seamless, secure handling of data can be immediately uploaded into the medical record is solved, patients’ care during cardiac arrests will still miss the mark. The RevivePro system seems to solve many of the glaring problems that face acquisition and handling of patient care information during Code Blue events.

Brian Ross, PhD, MD

Brian Ross, PhD, MD

Professor Emeritus, Department of Anesthesiology and Pain Medicine, University of Washington

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