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Code Crimson/Code Crimson Trauma Directions for Completion

Published byKellie Eaton Modified over 5 years ago

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Presentation on theme: "Code Crimson/Code Crimson Trauma Directions for Completion"— Presentation transcript:

1 Code Crimson/Code Crimson Trauma Directions for Completion
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.

2 Code Crimson/ Code Crimson Trauma
Adult-Allentown & Bethlehem Process Review 2013 St. Luke’s University Health Network

3 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 Crimson Trauma. List necessary laboratory tests obtained during a Code Crimson/Code Crimson Trauma. Utilize the Code Crimson/Code Crimson Trauma Record for documentation and critique.

4 Code Crimson/ Code Crimson Trauma
Complete replacement of a patient’s blood volume or a 10 unit PRBC transfusion requirement over 24 hours Typically present in hemorrhagic shock Treatment Rapid surgical control of hemorrhage Replacement of intravascular volume with appropriate blood components

5 What’s the Difference??? 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.

6 What’s the Difference??? Adult Code Crimson: Pediatric 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 Neonatal Code Crimson: Patient age is <30 days

7 What’s the Same? 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.

8 Blood Bank Communication
Blood Bank will contact dept. instituting the Code Crimson/Code Crimson Trauma Obtain gender & age of patient Exception: Trauma Bay and OR (Allentown and Bethlehem) will call Blood Bank directly and indicate gender & age of patient

9 Blood Products Trauma and Non-trauma adults will receive:
Code Crimson/Code Crimson Trauma-Cycle I 6 units PRBCs 4 units FFP 1 Single Donor Platelet

10 Code Crimson/Code Crimson Trauma Response Team
Bethlehem: Nursing Supervisor Blood Bank ICU RN (Transfusionist) Respiratory Therapist Operating Room Pastoral Care Rapid 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 Perfusionist Trauma Bay and Bethlehem Operating Room will not receive this response

11 What’s my role? Charge RN Primary RN Transfusionist Recorder/Scribe RN

12 Charge RN 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.

13 Charge RN Designates an individual (Runner) to obtain and transport blood products from the Blood Bank to the Code Crimson/Code Crimson Trauma location Pneumatic 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

14 Primary RN 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.

15 Transfusionist (ED, OR, ICU)
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 OR

16 Recorder/Scribe RN 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.

17 Code Crimson/ Code Crimson Trauma Labs
Initial lab tests: CBC Type and Cross PT/INR, aPTT, Fibrinogen Magnesium Phosphorous I-Stat with Base Deficit (performed by Resp. Therapist) Draw labs every 30 minutes while Code Crimson/Code Crimson Trauma continues: I-Stat with Base Deficit

18 Contents of Code Crimson/Code Crimson Trauma Packets
Code Crimson/Code Crimson Trauma Policy Initial lab tubes and 3 sets of every 30 minute lab tubes 1 Hemostat Initial lab tests ordering slip and every 30 minute lab tests ordering slip

19 Lab Tests Ordering Slips
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, 1015 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)

20 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.

21 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.

22 Hand-off 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

23 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 Platelet

24 Cycle II 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.

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28 Transfusion Process 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 Recorder/scribe RN will reconcile the unit # on tag with unit # indicated on documentation form Unit #: Code Crimson-Cycle I PRBC 1

29 Transfusion Process Recorder/Scribe RN
Verifies that the unit # on tag is listed on the documentation record and indicates time/volume infused. PRBC (350mL) Time Issued Time Infused Volume Infused PRBC 1 # PRBC 2 PRBC 3 PRBC 4 PRBC 5 PRBC 6 Unit #: Code Crimson-Cycle I PRBC 1

30 Unit # to be filled in by Blood Bank
Note: Time infused may be the same for products

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33 Code Crimson/Code Crimson Trauma Directions for Completion
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. Exit 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.

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