Nursing 11: Critical Analysis of a Code Blue Resuscitation Scenario

This report critically analyzes a 'Code Blue' resuscitation video, evaluating the procedures against Australian Resuscitation Council (ARC) guidelines and existing literature. The analysis identifies strengths and weaknesses in areas such as early recognition, compressions, defibrillation, handover, vital signs assessment, role assignment, debriefing, and documentation. The report highlights deviations from ARC guidelines, including issues with airway management, compression techniques, and the timing of interventions. It also discusses the importance of non-technical skills, such as communication and teamwork. Recommendations are provided for improving resuscitation practices, emphasizing the need for adherence to evidence-based guidelines and the importance of continuous professional development. The report underscores the critical role of healthcare professionals in providing timely and effective care during cardiac arrest scenarios. The video was meticulously analyzed to understand the aspects of practice that were poor and non-complying with the guidelines and research that supported the guidelines was also done. The breaches to the ARC guidelines are discussed, including technical and non-technical skills deemed fit for the resuscitation process.

Running head: NURSING
Complex Nursing
Name of student:
Name of university:
Author note:

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Table of Contents
Introduction......................................................................................................................................2
Early recognition.............................................................................................................................3
Compressions...................................................................................................................................4
Defibrillation....................................................................................................................................5
Handover..........................................................................................................................................5
Vital signs........................................................................................................................................6
Assignation of roles.........................................................................................................................7
Debriefing........................................................................................................................................7
Documentation.................................................................................................................................8
Social worker...................................................................................................................................8
Conclusion.......................................................................................................................................9
References......................................................................................................................................10

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Introduction
Healthcare professionals in the contemporary era need to be highly skilled and efficient
for addressing evolving needs of patients through advanced technologies. In critical care domain,
one of the most significant and critical care processes is resuscitation. Resuscitation refers to the
process of improving physiological disorders in patients who are accurately unwell Hospital
emergency codes are coded messages that are to be announced over a public address system of a
hospital for alerting on-site emergencies. Code blue indicates that there is an emergency as a
result of a patient suffering cardiac arrest. Research indicates that professionals must consider
maximum available evidences and existing literature for practicing resuscitation. The Australian
Resuscitation Council (ARC) is a voluntary co-ordinating body in Australia involved in the
practice and teaching of resuscitation. It is significant to follow the same since the guidelines is
highly evidence-based, bringing in key insights from research into practice. The guideline thus
meets the objective of fostering simplicity and uniformity in resuscitation techniques. In the
present paper an attempt is made to come up with a media annotation that reviews the video
titled “Code Blue’, focusing on resuscitation on an arrest scenario. A critical analysis is done to
identify the strengths and weaknesses of the procedure undertaken in light of the Australian
Resuscitation Council guidelines and existing evidences in literature. Recommendations are put
forward for better practice change.
A meticulous analysis of the video was undertaken to understand the aspects of practice
that were poor and non-complying with the guidelines. Comparison with existing literature was
also done to understand the relevant research that supported the guidelines. The breaches to the

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ARC guidelines are to be discussed first. This would include technical as well as no technical
skills as deemed fit for resuscitation process.
Early recognition
The healthcare professionals are to carry out DRS ABCD (dangers, responsiveness, send,
airway, breathing, CPR, defibrillation) assessment in the process of resuscitation. At the very
beginning of the video it is noted that the nurse calls out to her fellow nurse upon understanding
that the patient she was attending was in need of urgent support [.0.06 secs]. A rich pool of
literature indicates that nurses are supposed to use the emergency button for contacting other
professionals in the time of urgency. The aim is to reduce the time required for attending the
patient and providing with first line of care (Song et al., 2016; Aneman et al., 2015). All health
care facilities providing critical care are to have provision for emergency button so that the
process of resuscitation can be commenced appropriately.
According to (Wurster et al., 2017) the most important step is patient assessment prior to
resuscitation is assessment of the airway. The rationale is that proper airway management
increases the chances of speedy recovery. There were certain aspects in the resuscitation process
that were not apparently weaknesses, but could not be adjudged as strengths also. Firstly, though
the absence of seal in airway management process was a weakness, good non-technical skills
was evident in that the nurse asked for assistance without delay. Acknowledging failure to
comply standards and seeking assistance is appreciable (Ali et al., 2017). Further, the breathing
pattern of the patients was assessed by the nurse from distant height. As opined by (Tasker,
2016) an unresponsive patient is to be assessed properly for breathing pattern which entails the
professional to be at a suitable position near the patient. The nurse also did not adjust the height

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of the bed for assessing the breathing pattern of the patient. In the video it is noted that the nurse
was not considerate of removing the pillow so that the patient is placed in an appropriate position
to facilitate breathing. As per the ARC guideline (2016) professionals are to place the patient at a
position that facilitates proper assessment of the movement of upper abdomen and lower chest to
assess breathing pattern.
Compressions
Poor technical skills were also evident in that there was negligible professionalism shown
by the nurses while delivering compressions [0.39 secs]. The compressions were not rhythmic;
meaning the time difference between two successive recoils was not similar for all compressions.
Survival from cardiac arrest is dependent on two factors; early resuscitation and early
defibrillation. Resuscitation has to be rhythmic since irregular chest compressions lead to
artifacts in the ECG (de Guana et al., 2014). The code captain thought it to be appropriate to
interrupt the compression in order to check the patient’s heart rhythm. The ARC guideline
(2016) pinpoint that minimal interruptions are allowed while compressions are given. This is
supported by the research of (Partridge et al., 2015). The researchers state that compressions are
to be given in an uninterrupted manner as interruption affect survival. The nurse took a pause
while giving compression and resumes after few seconds. Nurses are expected to show
professionalism in applying in-depth knowledge of resuscitation process (Black, 2016;
Edmonson et al., 2016). A further analysis reveals that the depth of compression is a crucial
aspect for accurate resuscitation process. From the video it is seen that the nurses did not
consider avoiding movement of the patient and the depth of the compression was not
appropriate. The compressions were shallow and thus not effective. The ARC guideline (2016)
had stated that the lower portion of the sternum must undergo depression to at least one third of

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the depth of the chest in case of each compression. This equals to more than 5 cm in adults. The
guideline is supported by the research of de Guana et al., (2016) and Stiell et al., (2014). Present
resuscitation guidelines focus on high quality compressions with a depth of no more than 6 cm
and a rate of between 100 and 120 compressions per minute so that chest recoil between
compressions is ideal.
Defibrillation
The nurse considered mentioning ‘all clear’ to ensure that minimal interference was there
when the patient was subjected to shock [2.28 mins]. This is a sign of professional behavior and
the same also paves the way for safe environment (Chism, 2017). The code captain considered
carrying out ECG rhythm assessment before shock was delivered. From the ARC guidelines
(2016) it is understood that analysis of heart rhythm prior to resuscitation is of prime importance
for patient safety. This is based on varied research papers such as that of Rajan et al., (2017) and
Tanguay-Rioux et al., (2018) who point out those chances of survival is more when rhythm
analysis is done on time as there is a vital link between early rhythm detection and early
resuscitation. Moving on with the video it was pointed out that the nurse was considerate in
acknowledging the fact that the sinus rhythm strip had been printed with a time difference of ten
minutes [13.14 mins]. Code blue documentation is the basis for future care practices and all the
events of code should be documented accurately for reasons of continuity. Complete disclosure
of patient related information is to be included in the document (Jackson & Grugan, 2015).
Handover
Some of the factors that drive better patient outcomes in clinical care and particularly
resuscitation process include suitable handover process and appropriate administration of

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medications. This is understood by reflecting on the work of (Wagner et al., 2018). The ARC
guideline (2016) also recommends that when the medical emergency teams takes in charge of a
patient situation, an accurate handover at the time is required as soon as possible. In this
alignment Spangenberg et al., (2018) mentioned that exchange of patient information between
professionals at the early stage enables safe care practices. In the present scenario the code
captain was late in requesting for briefing of the situation. A briefing about the scenario and
patient condition at the earliest stage would have guided the code captain better to take suitable
actions.
Since the code captain prescribed epinephrine before checking for the patient’s tendency
to have allergic reaction to the same, the risk of patient harm was evident. Though administration
of medications after checking for allergic reactions in emergency situation is not always feasible,
it is advisable that the professional assesses patient’s previous records to understand whether
there are any risks of allergic reaction (Nolan, 2015). Hypersensitive reaction to certain drugs
decreases chances of survival for certain patients (Sacco et al., 2017). At this juncture it is
advisable that a code captain demonstrates assertiveness and leadership traits (Bennett et al.,
2017). Administration of adrenaline has been supported by literature. According to Anderson et
al., (2016) epinephrine (adrenaline) is used in resuscitation after cardiac arrest for a long time.
The effect of the drug is related to the alpha-adrenergic effects as a result of which there is
improved coronary perfusion pressure.
Vital signs
Another concern that arose in relation to technical skills is that there was no attempt to
record the blood glucose level, pulse, blood pressure and oxygen saturation of the patient. Poor

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practice is indicated in that blood pressure was recorded after the blood glucose level was
checked, and there was delay in checking the oxygen saturation (Black, 2016). Initial recording
gives a clear idea of the vital signs of the patient that influence resuscitation process since the
process is guided by suitable clinical decisions. Patients requiring resuscitation are at increased
risk of deterioration after the vital signs have returned to normal. Therefore early monitoring is
required for establishing an environment in which close monitoring and anticipatory care can be
provided. Vital signs can be assessed after the compression has been started (Schreiber et al.,
2015).
Assignation of roles
The weakness in demonstration of non-technical skills was pointed out when the
professionals failed to delegate their roles and carry out clinical tasks in an independent manner.
The ARC guideline (2016) mentions that professionals are to have clear understanding of the
tasks they are to perform in an independent manner in a code blue situation. In same regard
Porter et al., (2013) and Ford et al., (2016) mentioned that professionals are to have a proactive
approach in taking part in the resuscitation process. In the present case, the nurses did not have
sufficient knowledge of the tasks they needed to perform and moreover were not spontaneous in
acting as per the need of the hour. This delayed clinical decisions to be taken.
Debriefing
Further review of the video brings into limelight the concern that the debriefing process
could have been carried out in a better manner. The scribe did not consider discussing with the
professionals regarding the process carried out before requesting them to signs the document. It
has been mentioned in the ARC guideline (2016) mentions that quality of resuscitation can be

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highly improved if debriefing is done in a way that points out the areas needing further
improvement. It is recommended that nurses taking part in critical care are aware of their role
and tasks they need to perform. This can be done by engaging in communication with fellow
professionals that facilitates exchange of information. Group sessions as well as one-on-one
sessions promote exchange of ideas and opinions (Chism, 2017). Further, open communication
resolves interpersonal conflicts, if any, that might hamper patient care. An added weakness was
that no one did compressions when pads where put in place. According to CPR should not be
interrupted while the adhesive pads are being applied (Nolan, 2015).
Documentation
Appropriate documentation is vital in the successful completion of care process in critical
care unit. From the video it can be understood that documentation was not up to the standard.
The aim of accurate and complete record documentation in resuscitation process is to foster
quality and continuity of care. The scribe showed poor skills as she needed clarification on more
than one situation prior to documenting the detail. Nevertheless, recording of accurate patient
details enhanced patient safety. The medication name was confirmed on the first instance and
later the scribe confirmed the correct process undertaken between cardio version and
defibrillation. As highlighted by Copper et al., (2016) accurate patient data record ensures that
patient-centered care is provided. Any inaccurate documentation reduced the provision of
appropriate care, putting the patient at risk of harm. It is recommended that professionals taking
part in the resuscitation process such as the scribe enhance their skills through increasing their
knowledge (Nolan, 2015).

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Social worker
From the video it is noted that the social worker had a positive approach to inform the
family members of the patient. As per the Australian Resuscitation Council guidelines (2016),
family members of patients undergoing resuscitation are to be given the option of being present
at the time of resuscitation. Study by O’Connell et al., (2017) argue that presence of family
members at the time of recitation, if possible, leads to improved measures of positive emotional
and health outcomes, and coping. The ARC guideline (2016) strongly recommends that
prescience of family members at the time of resuscitation is valuable since the provision of
support of increased. The rationale for the same can be understood from the research paper of
Powers and Candela (2017) that has the opinion that coping is easier after successful
resuscitation when the patient has the support of the near ones. Positive health outcomes can be
achieved when the input of the family members is received, making it easier for the care givers
to understand the preferences of the patient (de Stefano et al., 2016).
Conclusion
In conclusion, the process of resuscitation holds much importance in trauma care,
intensive care and emergency medicine. The objective of practicing evidence based resuscitation
is to minimize the risks of patient harm and to ensure best patient outcomes within a stipulated
time. The present assignment was a valuable opportunity to understand guidelines for
resuscitation and the existing literature to support the same. Based on the learning from the
present annotation after a systematic analysis own professional practice can be enhanced in
future.

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References
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Perinatology, 37(2), 172. DOI: 10.1038/jp.2016.193
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Andersen, L. W., Kurth, T., Chase, M., Berg, K. M., Cocchi, M. N., Callaway, C., & Donnino,
M. W. (2016). Early administration of epinephrine (adrenaline) in patients with cardiac
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