Content – Team Dynamics and Leadership During Resuscitation

Team Dynamics and Leadership During Resuscitation

last authored: March 2015, Jessica Konecny, RN

 

 

Introduction

As health care professionals it is likely, depending on specific job title, that you will attend and participate in resuscitation situations. This article will describe the various Code Blue Team members and their roles.

 

Important to note, each institution will have their own policy regarding how to manage a resuscitation/Code Blue situation – if the reader is an employee/staff member, they should be well aware of their respective institution’s policy and accept this article as a supporting document.

 

 

Effective Communication

During a health care emergency, it is very important to be calm in a chaotic situation; each order and request should be stated loudly, however, avoid yelling as this will increase stress levels of the Team.

 

No other conversations should be occurring that are not pertinent to the code.

 

Closed loop communication from Team Leader (TL) to Team Member (TM) should be used. The TL should address specific a TM. The appropriate TM should acknowledge the order, and should clarify, confirm, or reject the order, based on their understanding and clinical competence. It is critical that this closed loop communication occur, so that the TL understands the situation. The recorder should also capturing each order and each event accurately.

 

If the TL is not sure of the next step, or forgets relevant information, it is appropriate to ask the group for their ideas. Likewise, if a TM has a suggestion, it may be made respectfully and when the timing is appropriate.

 

Role of Team Leader

Team Leader (TL) – Resuscitation should be run by only one person. Typically this will be the responding physician; however the TL may be a designate (e.g. RN) until the physician has arrived. It is the TL’s responsibility to communicate in a calm, clear manner how to approach the patient, which drugs or other life saving techniques to administer/apply/continue, whether other health professionals should be called to assist in the resuscitation. The TL also declares when the Code Blue is finished/completed.

If the TL must play an active role, they usually manage the airway – a position from which they may regularly assess the situation.

 

Role of Team Members (TM)

No one role is more important than another. Listen to the TL and respond accordingly. If you unsure of an order or are uncomfortable completing a task assigned to you it is your responsibility to speak up and ask for clarification or reassignment. The following describes the typical TM roles:

 

First Responder/Floor Staff – Call loudly for help and activate emergency response, according to your organizational policy.

After a pulse check and rapid physical exam, initiate chest compressions.

As other providers arrive, delegate the following tasks, according to competence:

  • ventilation
  • IV access
  • retrieval of crash cart
  • apply defibrillation pads
  • activate the AED
  • clearing the room, especially if another patient is in the room

 

Primary Care Nurse – The primary care nurse may or may not be the first responder. You need to be familiar with the patient’s medical history, history of stay, and recent clinical condition. If the Code Blue Team arrives before the physician, they will ask for this information. It is important that you are communicating with the TL when they arrive. You should stay with the patient.

 

Recorder – You will record all events of the code, including which Team Member does which intervention, all orders given,  location of IV access, timing of medication dose, etc.  Use one consistent clock for timing as you will notify TL at timed intervals for medication administration. Clarify anything you do not understand, and remember timing is important.

 

Runners – You will get any supplies the team may need, such as fluid or priming lines. Generally only two people are needed for this role as typically there will still be other patients on the floor that must continue to be cared for.

 

Respiratory therapy – Respiratory will establish and manage airway patency and ventilation as directed by TL. They may intubate the patient, or this procedure may be performed by the TL or another physician.

 

Code Team – typically comprised of critical care nursing staff, the Code team will push ACLS drugs according to DCA or TL once present. They may administer shocks if indicated. They will help switch out compressions with other team members.

 

 

Providing Feedback and Addressing Issues

The team leader, or any other member of the team, should remain observant of potential errors or omissions that could be occurring. These should be pointed out in an assertive but polite manner.

 

 

References and Resources

Bizzel, L. (2009, March 1). Emergency Situations- Code Roles. Retrieved December 1, 2014, from https://lane.stanford.edu/portals/cvicu/HCP_Emergency_Information_Tools/Emergency_Situation-Code_Roles.pdf

 

Adams, Dr Andrew (2011, June 1). Mode Code Training using Interdisciplinary Group Dynamics. Retrieved December 1, 2014, from https://www.ahn.org/sites/default/files/file/AGH – Mock Code – Participant Guidebook.pdf

 

Fitzgerald Chase, A. (n.d.). Team Communication in Emergencies – Simple Strategies for Staff. Retrieved December 1, 2014, from http://www.zoll.com/codecommunicationsnewsletter/ccnl04_10/ZollTeamCommunications04_10.pdf