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Code Blue and RRT Evaluation
Code Blue and RRT Evaluation
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Created by Qualaris Staff
Critical Access Hospital
Quality
Table of Contents
Audit Form
Audit Form
Code Blue and RRT Evaluation
Required
Observed Date
Unit
ED
ICU
Med-Surg
PACU
Rehab
Shift
AM
PM
Code Cart used
ED
ICU
Cardiology
OR
Response Type
Code Blue
Rapid Response Team
Did Code/RRT occur at change of shift?
Yes
No
Last time patient assessed prior to event? If known
Do not enter protected health information (PHI)
Patient Intubated
Yes
No
Difficulty with airway placement?
Do not enter protected health information (PHI)
If intubated was capnography applied?
Yes
No
NA
Code Blue and RRT Evaluation Checklist
Mark all as...
Was an RRT called prior to the Code Blue?
Yes
No
N/A
Issues or Concerns
Were any issues or concerns identified?
No
Yes
1) Communication
No
Yes
N/A
2) Equipment
No
Yes
N/A
3) Process/Flow
No
Yes
N/A
4) Personnel: All members present?
No
Yes
N/A
5) Medication tray issues
No
Yes
N/A
6) Any concern not already identified that needs reviewed?
No
Yes
N/A
Critique
American Heart Association guidelines followed?
Yes
No
N/A
Proper technique for chest compressions?
Yes
No
N/A
Standard precautions followed?
Yes
No
Documentation complete in EHR?
Yes
No
Please provide details of anything that was identified under the Issues or concerns/ and the Critiques sections
Do not enter protected health information (PHI)
Patient Disposition post arrest or RRT
Remained in room
Transferred to higher level of care (outside facility)
Transfer to ICU
Expired
