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Code Sample Procedures/Drills

Reference Guidelines:

Regular and unannounced code drills are useful practices in maintaining a high level of
emergency readiness throughout a long-term care facility. Drills should be planned to test
different department and shifts response. Drills ought to be executed at different times of the
day and week. All drills need to be documented by an observer to record results. After the drill,
the response and procedures should be reviewed and analyzed to determine effectiveness and
modified if necessary.

Code and emergency response actions should be included in all new staff orientation and
ongoing in-service trainings. Records of participation should be maintained in each personnel
file (or based on routine tracking process of the facility)

Code (Code Blue) Mock Drill

This is a tool to assist the center in identifying actions required during a code blue situation. (If
your facility has a different code name, ie DR STAT, replace code blue in document with your
current procedure)

Objective: The objective of the Mock Code Blue drill is to evaluate staff competency in the
management of cardiac/respiratory arrest or medical emergency in which additional staff
assistance is required.

Required Drill Frequency: Determine a time frame requirement for drills ie quarterly, monthly,
bi monthly etc. Ensure that drills are conducted in different departments of facility and on
different shifts and different days of the week. Complete on weekends- especially if you have
weekend only staff.

Preparation for Drill:

 Identify the time and place in which the mock code blue will occur
 Create a “dummy” chart that will be used as the code record. If you have electronic
health records that are used to identify code status, determine if a “dummy” record can
be established.
 The “dummy” record will need to include at a minimum the residents name, room
number, code status identifier, physician order, physician name and responsible parties.
 Utilize a manikin and identify with sign “I am coding” if available, or simply make a sign
that states code blue so staff know to initiate a drill. You can also utilize an employee as
a resident found not breathing.

Process for Drill:

 Call for help and state “Code Blue” and location (or whatever the facility has designated
for this circumstance”
 Describe scenario which is occurring (develop a script for situation (ie This is Mr. Jones,
he is 93 years old, found him lying outside of the bathroom door and he has no pulse
and no respirations)
 Identify a team leader for event (licensed nurse)
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 Incorporate any facility specific policies and processes in this step not identified

Team Leader assigns specific duties to staff:

 Verify residents code status (ensure during new staff orientation and ongoing this facility
specific process is reviewed)
 Bring emergency/code cart to scene (ensure during orientation that all staff are shown
where the emergency/code cart is stored)
 Initiate CPR/medical care/treatment
 Call 911 and give information
 Call physician and family
 Initiate emergency transfer forms
 Document the event and timeline
 Direct emergency services to location of event
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Mock Code Blue Checklist Observation

This observation is intended to guide clinical staff through specific tasks and not intended to be all inclusive. As always
clinical judgement should prevail. This material contains general information only and is not intended to be a substitute
for advice from a safety expert, regulatory or legal counsel. This resource does not guarantee compliance.

Questions/Observations Yes No Comments

Was a team leader identified?
Did team leader designate specific
duties to staff?
Was code status identified for
Was 911 called?
Was emergency/code cart brought
to room without incident?
Did code cart have all needed
equipment and all equipment
current with no expired products?
Was AED present, charged and all
equipment available? If applicable
Did someone initiate gathering
transfer paperwork?
Was physician notified?
Was family notified?
Was a staff member prepared to
guide EMS to the location of the
Did all nurses involved have
current CPR status?
Was CPR performed correctly?
Ask staff following questions:

If resident is a code and CPR

initiated when do you stop?
When you are alone and physically
exhausted and cannot continue

When EMS is on the scene and

takes over

When the resident recovers-heart

beating and breathing on their own
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Code Documentation Form Sample

Event Date: Event Time:

Location of Event: (ie room 212, east hall dining room)
Time 911 called:
Time EMS arrived at facility:
CPR initiated at what time:
CPR initiated by whom:
List all that provided CPR, if more than person listed above:

Documentation of vitals and time taken: BP, Respirations, Pulse, O2 saturation, O2

administered (route and how many liters):

Time Resuscitation event concluded:

Reason resuscitation ended: (check one)
 Return of circulation
 Efforts terminated per EMS
 Transferred to hospital

Describe Events, if needed: (ie peripheral IV placed, response to interventions, any documentation
not listed above)

Resident Name
Medical Record Number