Code Blue Response Documentation Checklist
Document comprehensive code blue/cardiac arrest response including CPR quality, defibrillation, medications, and team performance for quality improvement.
- Industry: Healthcare
- Frequency: Every code blue event
- Estimated Time: Post-event documentation
- Role: Code Team
- Total Items: 27
- Compliance: AHA ACLS Guidelines, Joint Commission Resuscitation Standards, Get With The Guidelines
Initial Response
First responder actions
- Unresponsiveness verified?
- Code called immediately?
- CPR started within 2 minutes?
- AED/defibrillator retrieved?
CPR Quality
High-quality CPR metrics
- Compression depth adequate (2-2.4 inches)?
- Compression rate 100-120/min?
- Full chest recoil allowed?
- Minimal interruptions (<10 sec)?
- Compressors rotated every 2 minutes?
Airway & Breathing
Airway management
- Airway opened (head-tilt/jaw thrust)?
- Bag-valve-mask ventilation effective?
- Advanced airway placed?
- Type of advanced airway
- End-tidal CO2 monitored?
Defibrillation
Shock delivery
- Initial rhythm analyzed?
- Initial rhythm
- Shockable rhythm present?
- Number of shocks delivered
- Shocks delivered with minimal pause?
Medications Administered
ACLS medications
- IV/IO access obtained?
- Epinephrine given per protocol?
- Amiodarone given (if VF/pVT)?
- Other medications documented?
Code Outcome
Final outcome
- ROSC achieved?
- Time to ROSC (if applicable)
- Code terminated time
- Family notified?
Related Healthcare Checklists
- Rapid Response Team Activation Checklist
- Crash Cart/Code Cart Daily Check Checklist
- Neonatal Resuscitation Documentation Checklist
- UK First Aid Needs Assessment Checklist
- Pharmacy Medication Storage Compliance Checklist
- Sterile Compounding Daily Checklist
- Ambulatory Surgery Pre-Operative Checklist
- Dialysis Treatment Monitoring Checklist
Related Emergency Preparedness Checklists
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- CMS Emergency Preparedness Compliance Checklist - FREE Download
- Rapid Response Team Activation Checklist - FREE Download
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- Neonatal Resuscitation Documentation Checklist - FREE Download
- UK First Aid Needs Assessment Checklist - FREE Download
Why Use This Code Blue Response Documentation Checklist?
This code blue response documentation checklist helps healthcare teams maintain compliance and operational excellence. Designed for code team professionals, this checklist covers 27 critical inspection points across 6 sections. Recommended frequency: every code blue event.
Ensures compliance with AHA ACLS Guidelines, Joint Commission Resuscitation Standards, Get With The Guidelines. Regulatory-aligned for audit readiness and inspection documentation.
Frequently Asked Questions
What does the Code Blue Response Documentation Checklist cover?
This checklist covers 27 inspection items across 6 sections: Initial Response, CPR Quality, Airway & Breathing, Defibrillation, Medications Administered, Code Outcome. It is designed for healthcare operations and compliance.
How often should this checklist be completed?
This checklist should be completed every code blue event. Each completion takes approximately Post-event documentation.
Who should use this Code Blue Response Documentation Checklist?
This checklist is designed for Code Team professionals in the healthcare industry. It can be used for self-assessments, team audits, and regulatory compliance documentation.
Can I download this checklist as a PDF?
Yes, this checklist is available as a free PDF download. You can also use it digitally in the POPProbe mobile app for real-time data capture, photo documentation, and automatic reporting.