Standardization Of Emergency Code Calls In Oregon
Standardization ofEmergency Code Callsin OregonDiane Waldo, MBA, BSN, RN, CPHQ, CPHRM, LNCCDirector of Quality and Clinical ServicesOregon Association of Hospitals and Health SystemsDirect Line: 503-479-6016Fax: 503-636-8310Cell 503-333-8577diane.waldo@oahhs.orgJanuary 2009To download a copy of this toolkit, go to http://www.oahhs.org click “Quality:Initiatives & Programs”
Table of Contents¾ Acknowledgements 2¾ Background 3¾ Emergency Code Recommendations 4¾ Emergency Code Call Information¾ Code Red - Fire 6¾ Code Blue –Cardiopulmonary Arrest 7¾ Code Orange – Hazardous Materials Spill Or Release 8¾ Code Gray – Combative Person 9¾ Code Silver – Person With A Weapon Or Hostage Situation 10¾ Amber Alert – Infant Or Child Abduction 11¾ Code External Triage –External Disaster 12¾ Code Internal Triage – Internal Emergency 13¾ Rapid Response Team 14¾ Code “Name” Clear – Clear Code 15¾ Implementation Materials¾ Keys to a Successful Implementation 17¾ Suggested Implementation Work Plan 18¾ Sample Policy and Procedure 21¾ Model Letter (Sample) 23¾ Employee Newsletter (Sample) 24¾ Staff Poster Sample #1 25¾ Staff Poster – Sample #2 26¾ Training Sessions 27¾ Staff Sign-In Sheet 29¾ Staff Competency Checklist 30¾ Emergency Code Presentation 32Emergency Code Callswww.oahhs.org "Quality: Initiatives & Programs"1
AcknowledgmentsWe would like to thank the taskforce and participating hospitals that worked ondeveloping the Emergency Code Calls. Quality leaders, security experts, disasterpreparedness, physicians, and nurses provided expert advice. The dedication tosafe care by the participating hospitals helped make this work a reality.Participating Organizations:Evergreen HealthcareHighline Medical CenterKing County Public HealthMultiCare Health SystemOregon Association of Hospitals & Health SystemsOregon Patient Safety CommissionOverlake Hospital Medical CenterProvidence Regional Medical Center EverettProvidence Health & Services – Portland Service AreaProvidence St. Peter HospitalSacred Heart Medical Center and Children’s HospitalSeattle Children’sSkagit Valley HospitalSwedish Medical CenterUniversity of Washington Medical CenterValley General HospitalWashington State Hospital AssociationYakima Regional Medical & Cardiac CenterSpecial thanks to:¾ Washington State Hospital Association (WSHA) who produced thesematerials based on documents from the Arizona Hospital and HealthcareAssociation, Healthcare Association of Southern California and LouisianaHospital Association¾ Pennsylvania Color Safety Task Force that developed the initial policy asthe basis for the Staff Competency Checklist.Emergency Code Callswww.oahhs.org "Quality: Initiatives & Programs"2
Emergency Code CallsBackgroundHospitals in Oregon and Washington are committed to safe, quality health carefor their communities. One way to promote safety and reduce harm is tostandardize emergency code calls in hospitals throughout both states. Thepurpose of emergency code calls is to communicate an emergency quickly and tomobilize expert assistance.Physicians and staff often work in multiple hospitals, each with their ownemergency code designations. It is easy to become confused and use the wrongcode in an emergency. This has resulted in harm to patients in Washington andseveral other states. Nine states have responded to the lack of uniformity amonghealth care facilities by standardizing emergency codes in their states. TheAmerican Hospital Association has recommended a set of codes for hospitalsacross the nation to use.At the request of member hospitals, the Oregon Association of Hospitals &Health Systems, Oregon Patient Safety Commission, and Washington StateHospital Association formed a taskforce to standardize emergency code callsunder the leadership of the Dr. Lawrence Schecter, chief medical officer,Providence Regional Medical Center Everett. Both states surveyed memberhospitals to determine the amount of variation in emergency codes. Althoughmany hospitals used the same code for fire (code red), tremendous variationexisted for codes representing respiratory and cardiac arrest, infant and childabduction, and combative person, reinforcing the importance of standardizationto support our physicians and staff who strive to deliver safe patient care.In our deliberations and decisions regarding the types and names of codes tostandardize, we adhered to the following principles:¾ the types of codes should be limited given that people have limited memorycapacity and fewer codes would be easier to remember ;¾ codes should be consistent with national standards where possible to fosterclear communication in the event of a national disaster and to address themultiple states also working on this same initiative;¾ definitions should be consistent, clear and brief;¾ in order to prevent confusion among hospital staff, the colors adopted shouldbe different from the colors adopted for the hospital color-coded alertwristbands where possible;Emergency Code Callswww.oahhs.org "Quality: Initiatives & Programs"3
¾ names for each code should reflect clarity and brevity; and¾ hospitals may add modifiers to codes as appropriate, for example, location ofthe emergency.Support for hospitals for standardization of emergency codes is being providedby the Northwest Organization of Nurse Executives, Oregon Association ofHospitals & Health Systems, Oregon Patient Safety Commission, andWashington State Hospital Association.Emergency Code Recommendations:The following code designations for emergency identification in health careorganizations are recommended code names:Code NameEmergency SituationCODE REDFireCODE BLUEHeart or Respiration StoppingCODE ORANGEHazardous Material Spill or ReleaseCODE GRAYCombative PersonCODE SILVERPerson with Weapon/Hostage SituationAMBER ALERTInfant and Child AbductionEXTERNAL TRIAGEExternal DisasterINTERNAL TRIAGEInternal EmergencyRAPID RESPONSE TEAMRapid Response Team“CODE NAME” CLEARTo Clear a CodeNote: It is important that location be included with any code announcement.Although this is a voluntary effort, hospitals in Oregon are encouraged to adoptthese emergency codes by December 31, 2009.Emergency Code Callswww.oahhs.org "Quality: Initiatives & Programs"4
Emergency Code Call InformationEmergency Code Callswww.oahhs.org "Quality: Initiatives & Programs"5
CODE RED - FIREPurposeCommunicate a risk and mobilize a response to protect patients, families, visitors, staff,physicians and property in the event of smoke and/or fire.Reason RED Was Selected for FireThe color red was selected because it is the universal color for fire and easy for staff toremember. The American National Standards Institute (ANSI) has designated red tocommunicate “Stop!” or “Danger!” It is also consistent with states that have alreadystandardized emergency code calls.Supporting InformationCode RED should be immediately initiated if a fire is suspected or observed. This mayinclude:¾ seeing smoke or fire;¾ smelling smoke or other burning material;¾ feeling unusual heat on a wall, door or other surface; or¾ notification by a patient, family member, visitor, staff or physician of a fire.A Code RED alarm may also be initiated automatically by electronic fire detectionequipment in the facility.Fire response procedures must be implemented upon suspicion of a fire.Notification of co-workers for a timely, effective and efficient response is critical tomaintaining safety and preventing damage.Other buildings on the hospital campus that are not part of the designated hospital willdial 911 for response.Emergency Code Callswww.oahhs.org "Quality: Initiatives & Programs"6
CODE BLUE –CARDIOPULMONARY ARREST(Adult/Child/Infant)PurposeCommunicate a risk and mobilize the immediate arrival of emergency equipment andspecialized personnel to an adult or child whose heart or respiration has stopped.Reason BLUE Was Selected for Heart or Respiration StoppingBLUE was selected because it is commonly used among Oregon and Washingtonhospitals to indicate a cardio-pulmonary arrest. It is also consistent with states that havealready standardized emergency code calls.Supporting InformationCode BLUE is called for patients who do not have an advance health care directiveindicating otherwise.¾ Code Blue is initiated immediately when an adult or child is not breathing orheart has stopped.¾ In some hospitals, a modifier may be added to indicate a pediatric or infantemergency.Other buildings on the hospital campus that are not part of the designated hospital willdial 911 for response.Emergency Code Callswww.oahhs.org "Quality: Initiatives & Programs"7
CODE ORANGE – HAZARDOUS MATERIALS SPILL ORRELEASEPurposeCommunicate a potential risk and activate a response that will protect patients, families,visitors, staff and physicians in case of a hazardous material spill or release, identifyunsafe exposure conditions and help to evacuate an area safely if necessary.Reason ORANGE Was Selected for Hazardous MaterialsSpill/ReleaseOrange was selected because it is the color most frequently associated with hazardouswaste signage and therefore is easy to remember. It is also consistent with states thathave already standardized emergency code calls.Supporting InformationCode ORANGE is called if there is a hazardous material spill/release that may causeinjury or illness, and/or result in exposure that exceeds state or federal exposure limits,or may harm the environment.¾ Staff should consult hospital policy and Material Safety Data Sheets (MSDS)before attempting to clean up the spill.¾ Health care facilities should establish a relationship with local fire and policedepartments, and include them in the overall planning and training programs.Other buildings on the hospital campus that are not part of the designated hospital willdial 911 for response.Emergency Code Callswww.oahhs.org "Quality: Initiatives & Programs"8
CODE GRAY – COMBATIVE unicate a potential risk and mobilize a response to protect patients, families,visitors, staff, physicians and property in the event of a combative person. If the personhas a weapon, “CODE SILVER” should be called.Reason Gray Was Selected for Combative PersonGray was selected in order to be consistent with the many other states that havestandardized emergency code calls. Please note that it is a similar color to the emergencycode call for weapon or hostage situation.Supporting InformationCODE GRAY is initiated when staff are concerned about their own safety or the safetyof others. Combative or abusive behavior can be displayed by patients, families, visitors,staff or physicians. Recognizing early warning signs are critical. These may include:¾ direct or verbal threats of harm;¾ intimidation of others by words and/or action;¾ carrying a concealed weapon or flashing a weapon to test reactions;¾ intentional disregard for the safety of others; or¾ destruction of propertyGenerally, a Code Gray is not announced overhead but a response team will be notified.The responding team will assist staff in managing and/or de-escalating the situation.Some hospitals may elect to add a modifier indicating if the code concerns a patient,visitor, staff member or physician.Other buildings on the hospital campus that are not part of the designated hospital willdial 911 for response.Emergency Code Callswww.oahhs.org "Quality: Initiatives & Programs"9
CODE SILVER – PERSON WITH A WEAPON ORHOSTAGE SITUATIONPurposeCommunicate a risk and mobilize a response team to assist staff in managing and/or deescalating a potentially threatening situation and gain the cooperation of a person with aweapon or who has taken hostage(s).Reason Silver Was Selected for Weapon or Hostage SituationSilver is the color of a gun, which makes it easy for staff to remember a weapon orhostage situation. It was also selected in order to be consistent with the other states thathave standardized emergency code calls.Supporting InformationAnyone can engage in hostile or violent behavior: Patients, family, visitors, staff orphysicians. When staff are concerned about their own safety or the safety of others andsuspects that someone has a weapon, they are to call a CODE SILVER.¾ When possible, staff members should not attempt to intervene or negotiate, butwait for the emergency team to arrive.¾ The definition of a weapon is any firearm, knife or instrument than can causebodily harm or injury.¾ This type of code will generally not be announced overhead, but a response teamwill be notified. When Code Silver is activated, a response from internalsecurity, and potentially external law enforcement, should be requested.Other buildings on the hospital campus that are not part of the designated hospital willdial 911 for responseEmergency Code Callswww.oahhs.org "Quality: Initiatives & Programs"10
AMBER ALERT – INFANT OR CHILD ABDUCTION(Infant/Child)PurposeAn AMBER ALERT should be initiated when an infant or child is missing or abducted.Reason Amber Was Selected for Infant or Child AbductionAmber Alert is easy for staff and visitors to remember as it is used nationally by lawenforcement for infant and child abduction. It is also used by many of the states thathave standardized emergency code calls.Supporting InformationThe following information is taken from “For Healthcare Professionals: Guidelines onPrevention of and Response to Infant Abductions” published by the National Center forMissing and Exploited Children. The typical abductor profile includes the followingcharacteristics:¾ frequently visits nursery and maternity units initially at more than one healthcare facility prior to the abduction; asks detailed questions about procedures andthe maternity floor layout; frequently uses a fire exit stairwell for her escape;¾ usually plans the abduction, but does not necessarily target a specific infant;frequently seizes on any opportunity present;¾ frequently impersonates a nurse or other allied health care personnel;¾ the abductor can be a stranger to the child, or a family member, such as a noncustodial parent; and¾ children can often verbally let someone know when they face a threateningsituation.Other buildings on the hospital campus that are not part of the designated hospital willdial 911 for response.Emergency Code Callswww.oahhs.org "Quality: Initiatives & Programs"11
CODE EXTERNAL TRIAGE –EXTERNAL DISASTERPurposeCommunicate the occurrence of a catastrophic event and provide a mechanism to allowthe healthcare facility to respond to the external emergency situation.Reason External Triage Was Selected for External DisasterExternal Triage was selected to be consistent with recommendations from the AmericanHospital Association. We recognize use of “Triage” in this instance differs from theusual usage in emergency departments.Supporting InformationThere are a variety of external emergencies in which mass casualties can result and thatmay affect hospitals. These can include:¾ any event where there are mass casualties;¾ flood, earthquake, other natural disaster;¾ massive power outages;¾ multi-vehicle accident, train derailment, bus or plane accident;¾ nuclear, biological and chemical incidents;¾ tornado ,severe weather; or¾ tsunamiWhen calling “External Triage”, important information to communicate is the type ofemergency, estimation of how many people are involved, how many are likely come toarrive at the hospital and any special considerations.Emergency Code Callswww.oahhs.org "Quality: Initiatives & Programs"12
CODE INTERNAL TRIAGE – INTERNAL EMERGENCYPurposeCommunicate a significant disruption to normal operations in all or part of thehealthcare facility and initiate contingency plans in response to the specific emergentsituation. It is to protect patients and staff and ensure continued operations of thefacility.Reason Internal Triage Was Selected for Internal EmergencyInternal Triage was selected in order to be consistent with recommendations from theAmerican Hospital Association. We recognize use of “Triage” in this instance differsfrom the usual usage in emergency departments.Supporting InformationAny internal event likely to significantly impact the ability of the hospital to functionacross multiple departments can prompt Internal Triage. Departments affected shoulddeal with the event as necessary, following the department specific plan. Examples ofwhat might trigger an Internal Triage are:¾ bomb or bomb threat;¾ computer or network down which is unanticipated and likely to last for asignificant amount of time;¾ explosion without fire;¾ flooding that needs emergency response;¾ plumbing outage or major problems;¾ power outage, utility disruption; or¾ telephones not working.Departments unaffected should stand-by for further information and instructions in casehelp is needed.All employees must be familiar with the evacuation routes and emergency plans in caseof emergencies.Modifiers may be used to indicate the type of internal event, such as power outage orcomputer system problems. If the internal event is a presents a safety risk, consider amodifier alerting staff to actions needed or where to get additional information.Emergency Code Callswww.oahhs.org "Quality: Initiatives & Programs"13
RAPID RESPONSE TEAMPurposeCommunicate that an immediate response and assessment is needed for a patientwhose medical condition is declining. This team provides additional support to thebedside nurse prior to the cessation of cardiac or respiratory function. Calling the RapidResponse Team serves as a second pair of eyes and support for the patient’s nurse. If thepatient’s heart or breathing stops, a “CODE BLUE” should be called.Supporting InformationThe Institute for Healthcare Improvement (IHI) has found that lives can be savedthrough early intervention. Indications for calling the Rapid Response Team include:¾ staff or family member is concerned about a patient’s condition;¾ acute change in respiratory rate 8 or 28;¾ acute change in pulse oximetry saturation to 90 despite O2;¾ acute change in heart rate 40 or 130 bpm;¾ acute change in blood pressure – systolic blood pressure 90;¾ acute change in consciousness state; or¾ acute change in urine output 50ml in 4 hours.This team can be summoned by patients, family, visitors and staff.Emergency Code Callswww.oahhs.org "Quality: Initiatives & Programs"14
CODE “NAME” CLEAR – CLEAR CODEWhen the code situation has been addressed or resolved, the hospital operator may pagethe “code name” and then announce “clear” to indicate the emergency situation hasended.Emergency Code Callswww.oahhs.org "Quality: Initiatives & Programs"15
Implementation MaterialsEmergency Code Callswww.oahhs.org "Quality: Initiatives & Programs"16
Keys to a Successful ImplementationSome considerations:Nurses, physicians and health unit clerks are the people that usuallymake emergency code calls; however, it is imperative that otherhospital employees be included in the education process. Take a fewminutes to observe the activities of the day at one of the nursingstations. In just a 30 minute observation, you will pr
Health Systems, Oregon Patient Safety Commission, and Washington State Hospital Association formed a taskforce to standardize emergency code calls under the leadership of
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132,230 calls were completed by the call center. 95,659 of the completed calls were inbound calls and 36,571 of the completed calls were outbound calls. The Program has completed 0 outreach event for this reporting period. The following events are scheduled for the week of January 8, 2018 – January 14, 2018:
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