Legal Issues with Code Blue

Did You Document?

This is one of the biggest issues we face in nursing. 

I truly feel nurses are awesome at what we do when it comes to actual hands-on.  However, when it comes to documentation; We Suck!  

Every nurse I know and have worked with; I would say that less than half; has ever wondered about the legal ramifications of an in-hospital cardiac arrest (code blue). Code blue events happen fast, and documenting the entire event correctly may be a difficult and daunting task.

Unfortunately,  in today's nursing environment; especially with the arrival of the EHR(electronic health record) nurses are becoming more vulnerable to legal actions.

If you don't document it wasn't done.  

Yeah Yeah!!  I know you have heard that a million times; but do you really listen? Nurses are being named defendants in malpractice lawsuits, according to the Nurses Service Organization(NSO).  "Of the 549 nurse closed claims, 88.5 percent involve RNs and 11.5 percent involve LPNs/LVNs." (NSO. 2015) If you work in the Emgerncy Room where a lot of code blues happen; those RN's see about 10.7% of claims against nurses.  

Professional liability insurance safeguards you against allegations of malpractice. While your employer may provide coverage for you, it may not be enough to cover you in all cases. Your employer's policy is designed to preserve the employers' needs and interests first.

When a code blue does have a negative outcome, the patient’s family may turn to the documentation for proof that the highest quality care was provided, or if errors were committed in order to seek justice.
An accurate documentation of timing is crucial. It’s important to know when each dosage is administered, and when the next should occur. Usually, the recorder keeps time as well as performs a majority of the legal documentation on the code sheet. 

"Over 30% of Code Blue paper charts are lost before they can be transcribed into an EMR. Of the paper charts not lost, 63% still contain substantive errors or are missing critical data." (Grigg, et al. 2014)  Any event in which a medical record containing sensitive patient information disappears constitutes a HIPAA violation.  The documentation needs to be placed in the EHR as quickly as possible, or your facility may not be providing adequate patient care.

Also, without a signature; any medication administered during the code blue event was given without a doctors order; this is why the code blue sheet has a spot for the medical doctor to sign. This in itself can constitute its own legal issue.  The signature also provides anyone who views the document with proof that the event was overseen by a trained healthcare professional. 

What to Do?

In order to improve ourselves in code blues overall; here are some tips to remember:

1. Improve code blue documentation
2. Improve your own personal documentation
3. Be familiar with your hospitals own code blue sheet
4. Learn to use your crash cart before a code happens
5. Take an Advanced Cardiac Life Support (ACLS) certification class
6. Hold Debriefings after the code blue
7. Initiate and Maintain a Code Blue Committee
8. Create Code Blue Teams and Roles

Code Blue can be scary and chaotic; however, this is the profession we chose to be in and if we want to make our profession stand out above and beyond the rest.  We must hold ourselves to a higher standard and decrease our documentation errors.

To learn more on how to protect yourself against law-suits and improve your patient safety.  Download the NSO Claim Report Here.

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