Code Green: An Effective Approach to Respond to Obstetric Emergencies Outside of the Labor and Delivery Unit
Title: Code Green: An Effective Approach to Respond to Obstetric Emergencies Outside of the Labor and Delivery Unit
- Describe the difference between medical and obstetrical emergencies.
- Identify roadblocks to efficient response and care of a patient when an obstetric ermergency happens.
- Describe ways to implement a more efficient way to alert specialized team members for response to an obstetric emergency.
During an emergency, a swift response by the healthcare team improves patient outcomes. This has been noted in most types of medical emergencies. Medical rapid response teams have existed in tertiary care centers for upto 30 years, becoming utilized more in the last 10 to 15 years. Many hospitals began seeing improved patient outcomes after forming rapid response teams.
Proposed change:
University Hospitals Case Medical Center (UHCMC) MacDonald Women's Hospital (MWH) has applied this process to obstetric emergencies in the obstetric units and is also creating a plan to implement this throughout all of UHCMC on every type of inpatient unit. The Code Green procedure was developed to alert specified team members of obstetric emergencies. The plan was to empower nurses to call a Code Green at the start of an obstetric patient's decline in order to access the correct medical team. Also, the goal was to decrease challenges of communication between different units and improve patient outcomes.
Implementation, outcomes and evaluation:
Several quality cases within the MWH with delays in patient care were analyzed. It was noted that many of them involved challenges in communication between the different obstetric units. An interdisciplinary team was developed including obstetricians, anesthesiologists, and nursing staff from all three obstetric units. The outcome was the inital Code Green response intended to be a systematic rapid response to patients who experience an obstetric emergency within the women's hospital.
A plan was created for a team consisting of the obstetric chief resident and a pre-specified nurse who would respond directly to the patient's location no matter where in the hospital that might be. Additional staff, including anesthesia, would be on standby. All hospital staff within MWH and the emergency department were educated using various methods prior to initiation.
Within the women's hospital communication and timeliness of response to emergencies has improved. However, the education has been found to be limited in the emergency department. The Code Green is not always used appropriately in this area. Re-education is being planned. Later, the Code Green will be opened to the entire inpatient setting to include any obstetric patient admitted to UHCMC.
Implications for nursing practice:
The new Code Green promotes empowerment of nurses to initiate rapid responses for obstetric patients off of the labor and delivery unit and access the correct medical team. It improves interdisciplinary communication leading to improved patient outcomes.
Keywords: obstetric emergency; obstetric rapid response; rapid response team