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On average, only one in four U.S. adults who experience in-hospital cardiac arrest (IHCA) survive to hospital discharge1,2 — yet many hospitals are achieving significantly higher survival rates.3-5 That’s why advocacy groups, such as The Joint Commission (TJC), have been updating their resuscitation standards, guidance, and recommendations to help more healthcare providers improve IHCA outcomes.

In this three-part series, we’ll take a closer look at how hospitals and clinical response teams can optimize factors that impact IHCA outcomes before, during, and after Code Blue events. We’ll include evidence-based best practices from TJC as well as the American Heart Association, IOM, and relevant clinical studies.

First up is Code Blue readiness. Keep reading to learn how prevention, training, and crash cart preparation can help healthcare providers reduce the incidence of IHCA and improve survival, outcomes, and clinical performance during Code Blue events.

Code Blue Readiness Consideration 1: Prevention

Preventing cardiac arrest may not only save a patients’ life, it can also prevent neurologic injury, myocardial dysfunction, reperfusion injury, and other conditions associated with post-cardiac arrest syndrome. 

Acute respiratory compromise, circulatory shock, and other signs of deterioration often precede IHCA. But studies show that clinicians frequently overlook important changes in vital signs and patient status that foreshadow these conditions.5-7

Increasing focus on tachypnea, tachycardia, hypotension, and other tell-tale physiologic changes can not only help to prevent IHCA from occuring in the first place, but also better prepare teams to respond if and when IHCA does occur.

Key takeaways5,7

  • Use early warning score systems to identify at-risk patients. At least one study reported that the incidence of cardiac arrests decreased significantly (from 4.67 to 2.91 per 1000 admissions) after the introduction of the modified early warning system.
  • Train rapid response teams (RRTs) or medical emergency teams (METs) to stabilize patients prior to arrest. Once deterioration is recognized, introduction of an RRT or MET is associated with a significant improvement in survival and decrease in overall incidence of IHCA.
  • Increase monitoring of deteriorating patients. After deteriorating patients have been cared for by RRTs, they should be assessed continuously, preferably in an intensive care unit (ICU). One study showed that every hour of delay in transfer to the ICU was associated with a 1.5% increase in hospital mortality.

Code Blue Readiness Consideration 2: Training

For patients experiencing cardiac arrest, a confident response by a practiced, coordinated clinical team is often the only chance for survival.

But Code Blue events are inherently stressful, not to mention time-sensitive and infrequent. Plus, response teams may consist of staff members who rarely work together, making it difficult to fully grasp the responsibilities and interconnections between various roles.

Regular training is essential to ensure responders maintain the knowledge, skills, and advanced teamwork capabilities they need to provide fast, effective, consistent IHCA care.

Key takeaways

  • Ensure a designated Code Blue team is available at all times.
  • Clearly delegate all team roles and responsibilities.
  • Conduct mock Code Blues throughout the year.
    • Take an adult ACLS course. Studies show that teams with at least one ACLS-trained member have better patient outcomes.
    • Incorporate a practice & mastery model. Evidence suggests that this improves skill acquisition and performance.
    • Implement booster training when using a mass learning approach. Brief, frequent sessions focused on repetition of prior content improves retention of CPR skills.
    • Conduct simulation-based training. New evidence shows that training in the in situ environment can improve speed and team performance as well as patient survival and neurological outcomes.

Code Blue Readiness Consideration 3:

Crash Cart Preparation & Organization

Crash carts are a central component of every Code Blue response. They contain everything clinicians need to resuscitate cardiac arrest patients — and they’re also perhaps the single most overlooked contributor to potential readiness hazards.

From the cart’s location to how it’s organized to proper stocking and storage of resources, crash cart management directly impacts clinical performance, quality of care, and time to care. In fact, The Joint Commission has noted that patient outcomes can be adversely affected by crash-cart-related safety risks, such as8:

  • Medication errors
  • Drained equipment batteries
  • Cart tampering or unsecured carts
  • Missing, expired, damaged, or contaminated resources
  • Failure to check or inspect carts per policies and procedures

Furthermore, there’s no reliable way to determine a cart’s code readiness at a glance, as even breakaway locks can be misleading and provide a false sense of security. Many of these issues are exacerbated by manual processes and lack of integration with other established hospital systems.

Key takeaways

  • Invest in automation technology to better manage crash cart inventory.
  • Keep carts in well-known, easily accessible locations, and ensure response team members are all aware of where their designated cart is located.
  • Use standardized checklists to reduce the potential for manual inventory management or cart check process errors.

Ensure Crash Cart Readiness with EMMA™

The EMMA Emergency Care System from Nuvara is the first and only information, medication, and equipment management solution for IHCA events. EMMA is designed to optimize Code Blue readiness by providing:

  • Complete, cloud-based digital inventory management via intuitive, purpose-built software, smart sensors, & an on-board barcode scanner
  • Integration with central pharmacy & supply systems as well as hospital formulary items
  • Streamlined, electronic cart checks
  • A consolidated, user-centric storage design, including a secure drawer for rapid sequence intubation drugs
  • Heightened awareness of cart and system-wide readiness via on-cart LED visual status indicators, automatic non-compliance and tampering alerts, & cloud-based cart check administration

Set emergency care teams up for success

True Code Blue readiness can only be achieved when clinical teams have the skills, information, and resources they need to save a life at a moment’s notice. Learn how the EMMA Emergency Care System can help by ensuring every cart stays code-ready.

References

  1. Virani SS, Alonso A, Benjamin EJ, et al. Heart disease and stroke statistics—2020 update: a report from the American Heart Association. Circulation. 2020 Mar;141:e139-e596.
  2. Holmberg MJ, Ross CE, Fitzmaurice GM, et al. Annual incidence of adult and pediatric in-hospital cardiac arrest in the United States. Circ Cardiovasc Qual Outcomes. 2019 July;12:1-8.
  3. IOM (Institute of Medicine). 2015. Strategies to improve cardiac arrest survival: a time to act. Washington, DC: The National Academies Press.
  4. Chan PS, Krein SL, Tang F, et al. Resuscitation practices associated with survival after in-hospital cardiac arrest: a nationwide survey. JAMA Cardiol. 2016;1(2):189-197.
  5. Kronick SL, Kurz MC, Lin S, et al. Part 4: systems of care and continuous quality improvement. 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(suppl 2): S397-S413.
  6. Andersen LW, Holmberg MJ, Berg KM, et al. In-hospital cardiac arrest: a review. JAMA. 2019 March; 321(12): 1200-1210.
  7. Nishijima I, Oyadomari S, Maedomari S, et al. Use of a modified early warning score system to reduce the rate of in-hospital cardiac arrest. J Intensive Care. 2016; 4 (12). doi: 10.1186/s40560-016-0134-7
  8. The Joint Commission. Crash-cart preparedness. Quick Safety. 2017 Apr; 32:1-3.