Code Crimson/Code Crimson Trauma - PowerPoint Presentation

Slide1

Code

Crimson/Code

Crimson Trauma

Adult - Allentown

&

Bethlehem Process Review 2013

Directions for Completion

1. Before

proceeding to the posttest, be sure you

review the

PowerPoint© program that follows this slide and the APPM

(policy &

attachments

)

Code

Crimson\Code Crimson Trauma

(#8)

.

2. When done, exit the PowerPoint© program and complete

the posttest

which

is final step of this education.

 “

Take Test”

 Remember

, no attendance record is needed.

 Completion

of the posttest will be sent electronically to your

EduTracker

record once a 100%

is achieved.



Print

the Certificate of Completion for your records if desired.

3. Comments

, question, or suggestions can be directed

to your

unit/department educator

or

manager.

The Trauma Program

Manager/educator can also be consulted with questions. Slide2

Code Crimson/

Code Crimson Trauma

Adult-Allentown & BethlehemProcess Review2013

St. Luke’s University Health NetworkSlide3

Objectives

At the completion of this education, the participant will be able to:

Identify the different roles and responsibilities of nursing staff during a Code Crimson/Code

C

rimson

T

rauma.

List necessary laboratory tests obtained during a Code Crimson/Code

C

rimson

T

rauma.

Utilize the Code Crimson/Code Crimson Trauma Record for documentation and critique.Slide4

Complete replacement of a patient’s blood volume or a 10 unit PRBC transfusion requirement over 24 hours

Typically present in hemorrhagic shock

TreatmentRapid surgical control of hemorrhageReplacement of intravascular volume with appropriate blood components

Code Crimson/

Code Crimson TraumaSlide5

Code Crimson: A

page alert designated to activate the alert team members to respond to a

non-trauma massive transfusion event. Code Crimson Trauma: Designated for trauma patients.

A physician or his/her designee will call the operator to announce the location.

Exception: Trauma Bay and Bethlehem OR will call Blood Bank directly for all Code Crimson/Code Crimson Trauma alerts.

What’s the Difference???Slide6

Adult Code Crimson:

Patient age is >14 years

Can be a Code Crimson or a Code Crimson Trauma

Pediatric Code Crimson:

Patient age is >30 days and <14 years

Can be a Code Crimson or a Code Crimson Trauma

Neonatal Code Crimson:

Patient age is <30 days

What’s the Difference???Slide7

Processing of Code Crimson/Code Crimson Trauma blood will receive the highest priority in the blood bank, using either O negative or O positive units.

Trauma and Non-trauma

adult patients will receive the same quantity and type of blood products.

What’s the Same?Slide8

Blood Bank will contact dept.

instituting the Code Crimson/Code Crimson Trauma

Obtain gender & age of patientException: Trauma Bay and OR (Allentown and Bethlehem) will call Blood Bank directly and indicate gender & age of patient

Blood Bank CommunicationSlide9

Trauma and Non-trauma adults will receive:

Code Crimson/Code Crimson Trauma-Cycle I 6 units PRBCs 4 units FFP

1 Single Donor Platelet

Blood ProductsSlide10

Code Crimson/Code Crimson Trauma Response Team

Trauma Bay and Bethlehem Operating Room

will not receive this response

Bethlehem:

Nursing Supervisor

Blood Bank

ICU RN (

Transfusionist

)

Respiratory Therapist

Operating RoomPastoral CareRapid Response Team If Code Crimson Trauma-Trauma Team responds

Allentown:

Nursing Supervisor

Blood Bank

ICU RN (

Transfusionist

)

Respiratory Therapist

Pastoral Care

Anesthesia

Rapid Response Team

On-call

P

erfusionistSlide11

Charge RN

Primary RN

TransfusionistRecorder/Scribe RN

What’s my role?Slide12

Coordinates the notification of the Code Crimson/Code Crimson Trauma by paging the operator.

Designates a Recorder/Scribe RN to document the events of the Code Crimson/Code Crimson Trauma.

Charge RNSlide13

Designates

an individual (Runner) to

obtain and transport blood products from the Blood Bank to the Code Crimson/Code Crimson Trauma locationPneumatic tube will not be used for transport of Code Crimson/Code Crimson Trauma blood products.Inform the runner on quickest route to Blood Bank

Exception

:

The Blood Bank will deliver blood products to the

Bethlehem OR

Charge RNSlide14

Obtains Code Crimson/Code Crimson Trauma Packet (Located on top of Code Cart).

Assists with IV access as necessary and infusion of fluids as ordered.

Coordinates the obtainment of blood work.

Primary RNSlide15

Responds to the Code Crimson/Code Crimson Trauma location with Rapid Infuser and tubing.

Transfuses blood products via the Rapid Infuser with blood warmer.

OR: Bethlehem: Transfuses all OR alerts

ED

: Transfuses all Trauma Bay and ED alerts

ICU

: Will respond to all Code Crimson/Code Crimson Trauma alerts in all hospital

areas, except for the OR and ED

Exception

-Allentown: ICU will respond to the ORTransfusionist (ED, OR, ICU)Slide16

Documents the events of the Code Crimson/Code Crimson Trauma on the designated form.

Form will arrive with first cooler of blood products from the Blood Bank.

Completes the Code Crimson/Code Crimson Trauma Critique located on the back of the documentation form and ensures all required signatures are obtained.

Recorder/Scribe RNSlide17

Initial lab tests:

CBC

Type and CrossPT/INR, aPTT, FibrinogenMagnesiumPhosphorous

I-Stat with Base

Deficit (performed by Resp. Therapist)

Draw labs every 30 minutes while Code Crimson/Code Crimson Trauma continues:

PT/INR,

aPTT

, Fibrinogen

I-Stat with Base Deficit

Code Crimson/Code Crimson Trauma LabsSlide18

Code Crimson/Code Crimson Trauma Policy

Initial lab tubes and 3 sets of every 30 minute lab tubes

1 HemostatInitial lab tests ordering slip and every 30 minute lab tests ordering slip

Contents of Code Crimson/Code Crimson Trauma PacketsSlide19

Lab Tests Ordering Slips

Nurse to place “X” on labs to be sent, place patient sticker on each lab tube and send with ordering slip to Lab (no need to place order in HEO)

Initial Lab Tests Ordering Slip

_____CBC

(

Lav

, 3ml)-Lab

# 205

______

Type and

Crossmatch (Lav, 6ml)-Lab # 2600

______ PT/INR,

aPTT

, Fibrinogen (Blue, 3ml)-Lab # 1007, 1010,

1015

______ Magnesium and Phosphorous (Green/Yellow, 4ml)-Lab # 3529,

3117

Every 30 Minutes Ordering Slip

______ PT/INR

,

aPTT

, Fibrinogen (Blue, 3ml)-Lab # 1007, 1010, 1015Slide20

What happens after the Code Crimson/Code Crimson Trauma is over?

Charge RN:

Notifies the Blood Bank immediately that the Code Crimson/Code Crimson Trauma has stopped.

Coordinates the re-stocking of the Code Crimson Packet (i.e. lab tubes and lab ordering slips)

Primary RN:

Coordinates all unused blood products are returned to the Blood Bank

immediately

.

Recorder/Scribe RN:

Completes the Code Crimson/Code Crimson Trauma Record and Critique.

Ensures original record is placed on chart and copies are sent to the appropriate department.Slide21

What if the patient is transferred to another

level of care during the Code

Crimson/Code Crimson Trauma?Code Crimson/Code Crimson Trauma continued by receiving department, including the completion of the Code Crimson/Code Crimson Trauma Record.

Primary RN: Provides SBAR hand-off report to receiving department, including total amount and type of blood products received and amount and type waiting for transfusion.Slide22

Signatures during hand-off:

Note that there are multiple areas on the documentation form for

transfusionists’ signatures. All transfusionists must sign documentation form

During hand-off, recorder/scribe RN and primary nurse will provide their signatures in the Clinical Notes section of the documentation form

Recorder/scribe RN and primary nurse ending the Code Crimson/Code Crimson Trauma will provide signatures on the designated area

Hand-offSlide23

What if all the blood products from Cycle I have been transfused, but the physician wants more blood products?

Immediately after Cycle I blood products have been transported, the Blood Bank will begin preparing Cycle II.

Code Crimson/Code Crimson Trauma continues until the lead physician orders to stop.

Cycle II-Bethlehem only

4 PRBCs

4 FFP

1 Single Donor PlateletSlide24

Immediately after transporting Cycle I, the runner will return to the Blood Bank to transport Cycle II.

The Blood Bank will send a new Code Crimson/Code Crimson Trauma Record with each subsequent cycle.

Cycle IISlide25
Slide26
Slide27
Slide28

Transfusionist

(ED, ICU, Bethlehem OR Only)1. Pulls off white/red tag from blood product.2. Places sticker (located in cooler) on white/red tag

3. Gives recorder/scribe RN tag for documentation on form

R

ecorder/scribe RN will reconcile the unit # on tag with unit # indicated on documentation form

Transfusion Process

Code Crimson-Cycle I

PRBC 1

Unit #: 123456789Slide29

Recorder/Scribe RN

Verifies that the unit # on tag is listed on the documentation record and indicates time/volume infused.

Transfusion Process

Unit #: 123456789

PRBC (350mL)

Time

Issued

Time Infused

Volume

Infused

PRBC

1

#123456789

PRBC 2

PRBC

3

PRBC

4

PRBC

5

PRBC 6

Code Crimson-Cycle I

PRBC 1Slide30

Unit # to be filled in by Blood Bank

Note: Time infused may be the same for productsSlide31
Slide32
Slide33

Code

Crimson/Code

Crimson Trauma Adult - Allentown & Bethlehem Process Review 2013

Directions for Completion

1. Before

proceeding to the posttest, be sure you

have reviewed APPM #8

Code

Crimson\Code Crimson Trauma

& the attachments to the policy

.

2.

E

xit this slide and complete

the posttest

which

is final step of this

education

.

 Click on “Take

Test”

 Remember

, no attendance record is needed.

 Completion

of the posttest will be sent electronically to your

EduTracker

record once a 100%

is achieved.



Print

the Certificate of Completion for your records if desired.

3. Comments

, question, or suggestions can be directed

to your

unit/department educator

or

manager.

The Trauma Program

Manager/educator can also be consulted with questions.