Are Family Members Allowed in Code Blue?

Allowing family members to remain with patients during code blue procedures has been a debated topic in the healthcare environment for many years.

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A great diversity in opinions exists on the subject among healthcare providers. A great diversity in opinions exists on the subject among healthcare providers. According to statistics, only 5% of hospital units have any type of formal written policy to use as a guideline for these situations. This lack of written policy has added controversy and confusion amongst healthcare providers.

Current trends are moving towards allowing family members to be present during cardiopulmonary resuscitation (CPR) and other procedures. Studies show great disparity in opinion exists depending on the type of practice. Nurses are far more likely to support family presence than are doctors. Resident physicians are the least open to family members remaining with the patient during a cardiopulmonary resuscitation (CPR). Should Family Members Be Allowed In Code Blue? Allowing family members to remain with patients during code blue procedures has been a debated topic in the healthcare environment for many years.

A great diversity in opinions exists on the subject among healthcare providers. According to statistics, only 5% of hospital units have any type of formal written policy to use as a guideline for these situations (Doyle, 2007). This lack of written policy has added controversy and confusion amongst healthcare providers. Current trends are moving towards allowing family members to be present during cardiopulmonary resuscitation (CPR) and other procedures. Most healthcare professionals have been found to have positive feelings about allowing family members to remain during code situations.

Studies show great disparity in opinion exists depending on the type of practice. Nurses are far more likely to support family presence than are doctors. Resident physicians are the least open to family members remaining with the patient during a cardiopulmonary resuscitation (CPR). One study done by the American Association for the Surgery of Trauma, found that 75-80% of its physician members were opposed to family members being present during resuscitation or invasive procedures (Duran, Oman, Jordan, Koziel, & Szymanski, 2007).

According to physicians, having family presence during resuscitation also has some serious drawbacks. Resuscitation is an intense situation; where every second is critical. Their major concern is that there is no distressed family member present that could interfere with the resuscitation efforts. If family members are present, this will distract attention from the patient and the care he/she needs. Not having family members present during cardiopulmonary resuscitation (CPR) will allow the staff to continue to work effectively in the midst of this critical situation.

One question that is asked many times by medical providers is the following: “Is it feasible to implement a family presence intervention during medical resuscitation in an emergency department using national guidelines to ensure appropriate family member behavior and uninterrupted patient care”? For some, it is also believed that family presence throughout cardiopulmonary resuscitation present problems. Fear that the staff might be distracted from providing needed patient care by distraught family members, is a physician’s main concern (Walsh, 2004).

Throughout these codes, many times the cardiopulmonary resuscitation (CPR) team demonstrates a quick ability to provide the best care under stressful and intense situations. Many physicians fear the cardiopulmonary resuscitation team will have difficulty controlling their own emotional response with the family present. Another point they are also concerned with is the patient’s code might be prolonged in futile situations because of the requests of the family members. This increases anxiety that an overwrought family member might hurt himself due to their reaction of the scene.

If the family member faints, resources could be diverted away from resuscitating the patient. There could be accidental exposure to blood and body fluids thus endangering family members to other unknown pathogens. This then leads to a final point, but most valid point, that there is not enough room in an emergency to accommodate the family throughout a code. There may have to be a limit to the amount of family members that may be present in a code due to the small rooms available in healthcare facilities and the amount of equipment needed to save the patient’s life.

In a survey, when asking several physicians about their opinion on having family members present throughout a cardiopulmonary resuscitation, a Vancouver physician stated: “To watch a team of strangers frantically shove tubes down the throat of a relative pierce each arm with large-gauge needles, or, in extreme situations, crack open the chest, would not only be traumatic to observe but could also leave the relative with a horrifying final memory. ” (American College of American Physicians, 2008). As mentioned before, there is a very high percent of physicians that do not believe that this may be particularly safe for the patient.

As patient advocates, physicians feel their main concern is first the well being of the patient and then the family They feel that the family will have an unpleasant, haunting, constant memory reminding them when the patient was at the worse time of their lives. In conclusion, bringing a family member to the bedside should not happen haphazardly but should be handled with careful consideration and define expectations. The best practice should be to educate healthcare staff during advance cardiac life support (ACLS), advance trauma life support (ATLS), and fundamental critical care support (FCCS). The patient’s and family wishes should be honored whenever possible.