CODE BLUE Evaluation Form

CODE BLUE Evaluation Form

Was the MET Call initiated prior to the CODE BLUE?

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Were resuscitative measures (i.e. chest compressions, rescue breathing) in progress upon code team arrival?

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Were all Code Team members present?

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Was Initial rhythm V. tach / V. fib?

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Was CODE BLUE record completed?

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Was patient easily accessible to the code team?

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Was patient assigned nurse present during the Code?

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Was the Family notified?

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Was the primary care physician notified?

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Were there any equipment or supply issues?

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Did patient survive the CODE BLUE?

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Did the code team follow ACLS protocol?

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Were there any other issues during the CODE BLUE that we can improve upon?

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Were there processes that went particularly well and should be celebrated?

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