Document Type

Assistance Policy
Document Title
Yellow Code Adult Morumbi

YELLOW CODE ADULT MORUMBI

INTRODUCTION

HIAE has on-call physicians, 24 hours a day, in Intensive Care Units and
First Aid authorized to assist patients in situations of
emergency/urgency, hospitalized or outpatient in the physical facilities of the Unit
Morumbi - HIAE and IIEP.

The Yellow Code consists of the early recognition of acute changes in the parameters.
vital signs in the adult patient, previously established, which will allow the nurse to activate the
on-call doctor, streamlining the service.

In the occurrence of Cardiac Arrest (CA) in adult patients, in the Unit.

Morumbi, this policy is not applicable, the 'Service Policy' must be followed.
Cardiac Arrest

OBJECTIVE

Ensure that any patient admitted and/or using the physical facilities of the Unit
Morumbi - HIAE and IIEP, shall be properly identified and treated during emergencies,
emergencies, intercurrences and need for medical evaluations, even in the absence of your
primary physician, without their prior consent.

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The Yellow Code aims to adopt the best practices proposed in the literature and recommended.
through the International Campaign One Hundred Thousand Lives (100K lives) with the following objectives:

Reduction of intra-hospital mortality

2. Reduction in the number of CPRs and greater survival of these patients,

3. Promote the Safety of the Patient, the Doctor, and the Institution.

DEFINITIONS

It applies to adult patients in emergency/urgency situations at the Morumbi Unit,

according to previously defined activation criteria.
This type of care is time-dependent and must occur within 5 minutes from
activation by the nurse. That is, the nurse notifies "Yellow Code" to the
CTI-A Secretary, at extension 79000, should immediately call the doctor so that
the patient should be attended to within this specified time.

In case of failure in the switchboard system, use the code from the contingency cell phone 99642-
8973

CRITERIA FOR THE APPLICATION OF THE POLICY

ACUTE CHANGES IN THE GENERAL CONDITION OF THE PATIENT:

Respiratory compromise:

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Acute decrease in O2 saturation to < 90%
Change in Respiratory Rate to < 8 rpm or > 28 rpm

Circulatory compromise:
Decrease in systolic blood pressure to <- 90 mmHg
Increase in systolic blood pressure to > 180 mmHg associated with symptoms
Change in heart rate to < 40 bpm or > 130 bpm

Neurological commitment:
Lowering of the level of consciousness
Seizure
Sudden focal signs
Diagnostic hypothesis of stroke with less than 12 hours of evolution
Suspected stroke

Clinical deterioration alert in hospitalized patients:

MEWS >= 6

Seriously concerned about the patient's overall condition:

Patient reports feeling "not well" or sensing "something wrong".
Change of color, humidity, and decrease in temperature at the patient's extremities
(pale, grayish, damp or cyanotic extremities)

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Situation involving disturbance of thoughts, feelings, or actions that poses a risk
significant for the patient or for others, requiring immediate intervention,
characterizing psychiatric emergency.
Fall with (or potential) moderate or severe damage. (these are examples of fall with damage
moderate or severe: fall with traumatic brain injury, loss of consciousness, inability to move or

mobility impaired after the fall, that is, situations where the consequence of the fall puts
At risk to patient safety. At this moment, the nurse's assessment is essential.

Note: in cases of falls with no damage or minor damage, the nurse will report the
patient's doctor (primary or assistant) regarding the occurrence of the fall; in case of impossibility
After proceeding with the assessment, the nurse will inform the on-duty physician in the ICU at the extension of

secretary 71500 about the occurrence of the fall and the need for the patient's evaluation in
up to two hours after the fall, as described in the document 'Prevention Protocol'
adult and pediatric dose

Specialized medical evaluation:

In situations of urgency/emergency surgeries, the on-call doctor of the Yellow Code
you can call the Surgical Code at extension 73030 +1 to confirm the
activation and follow the service flow as described in documentation
specific.

The HIAE anesthesia team is on duty 24 hours at extensions 76450 or 76451 for
support and/or anesthetic evaluation in situations of surgical complications.

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In case of difficult airway during the procedure, the VAD code can be activated.
peloramal 78000
For the care of Psychiatric Urgencies and Emergencies, the on-call doctor of
Yellow Code should notify the institutional psychiatrist (Psychiatric Risk) nocellular
99917.0848 for joint evaluation of the patient. The psychiatrist and the attending physician will attend.
the patient together, with the psychiatrist's role being to guide the conduct (physical and
medications) and special care related to the condition and management of the patient,
as well as possible complications. The risk psychiatrists will assist in the care.
in person for up to 15 minutes (from 08:00 to 18:00 from Mon to Fri) or by phone
at other times.

In situations of suspected stroke during the Yellow Code care, the doctor
you can activate the AVC Code on Extension 76177 so that the protocol neurologist
can evaluate the patient on site and proceed with the care as described in
specific documentation.

In cases of STEMI during the Yellow Code service, the doctor

You can contact the cardiologist from CORO, Extension 79522, so he can evaluate the
patient on site and continue with the care as described in the documentation
specific.

Criteria for Activation of the Yellow Code in the RPA:

Patients who meet the above-mentioned criteria must be assessed by the anesthetist.
responsible, in their absence the local nursing must activate the Yellow Code
directly, without prior assessment by the doctor. In the presence of the anesthetist, they must alert the

Yellow Code if the patient does not stabilize in 20 minutes.

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Criteria for Activation of the Yellow Code in the MDA not disregarding the
possibility of activation if patients meet the criteria mentioned above:

Relevant diagnostic findings in imaging:

HEAD: Focal or extensive diffuse lesions with significant mass effect; Deviation
importance of midline structures (> 1.0 cm) with risk of brain herniation;
Diffuse loss of intracranial liquor spaces with risk of brain herniations;
Voluminous hydrocephalus with risks of brain herniations; Hemorrhage in the brainstem or
cerebellum with mass effect or compression of the fourth ventricle; subarachnoid hemorrhage
extensive without known cause (suspected probable ruptured aneurysm).
NECK: Mass or hematoma with imminent risk of complete airway obstruction
superior; Vascular injuries with large hematoma or with active bleeding
THORAX: Large/tension pneumothorax; Large hemothorax (with risk of
hemodynamic instability) with or without active bleeding; Pulmonary thromboembolism
mass (with risk of hemodynamic instability) # Expansive formation with imminent risk
of complete airway obstruction; extensive pulmonary consolidation compromising
practically all pulmonary parenchyma
ABDOMEN: Massive parenchymal hemorrhage or hemoperitoneum/hemorrhagic peritoneum
voluminous (imminent risk of hemodynamic instability) with or without active bleeding;
Severe mesenteric necrosis with pneumatosis; extensive mesenteric thrombosis
- AORTA:Dissecção aguda; Ruptura

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Relevant diagnostic findings in cardiology:

IAM or SCA in progress;
Potentially fatal arrhythmia (SVT, VF, Torsades de Pointes, AV block with low output);
Complicated type A aortic dissection (pericardial effusion or significant aortic regurgitation)
coronary obstruction;
Cardiac tamponade;
Acute respiratory failure with the need for ventilatory support (ETI/sedation);
Persistent hypotension after fluid resuscitation;
Excessive sedative effect (sedation > moderate) not reversed with antidote;
-AF or other tachyarrhythmias without imminent risk during examination (especially stress echo) and
not reversed;
Uncomplicated and previously undiagnosed type A or B aortic dissection;
Complicated infectious endocarditis or previously undiagnosed endocarditis;
Situation that the examiner considers as hospitalization in an external client

RESPONSABILIDADES

UTI – On-Duty Physician

Management Group of the Codes

Agents Activity Descriptions

Detect one or more of the Acute Changes in General Condition

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Patient and requests Nurse Evaluation.
Assistance Team of the Unit: in certain units, due to unavailability
immediate care from the nurse, other healthcare professionals will be able to

activate the yellow code, following prior training.

Example: MDP.

Dial extension 79000 (CTI-A Secretary), informing:

Yellow Code, the name and location of the patient (floor,
Unit Nurse block and room number.
In case of activation due to cardiovascular reasons, request at
extension 76418 ECG at the site of the incident (floor and block)

Immediately call the on-duty doctor, informing,

CTI-A Secretariat Yellow Code, the name and location of the patient (floor,
block and room number

Guide the patient and family about the procedure;

Provide the emergency cart in the patient's room;
Assistance team at the unit checks vital signs and prepares the glucometer;
Install the pulse oximeter;
Monitor the patient with ECG on the defibrillator if triggered.
due to cardiovascular reasons
Install nasal O2 catheter at 2L/min if saturation < 90%;
Calm the family;

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The Care Team of the Unit begins the filling out of the Registration form in the system.
Yellow Code Adult
Request physiotherapy assistance from the ward if support is needed.
ventilator; during care and/or transport (NIV,
mechanical ventilation, assistance in IOT or if medical request
Units without physiotherapy such as MDA must call the physiotherapist.
ICU reference at extension 76532

Go to the service area respecting the deadline set in

protocol up to 5 minutes;

Evaluates the patient, diagnoses the situation, prescribes.

Yellow Code Doctor* drugs and initiates procedures, if necessary;
Request transfer of the patient to the patient department
graves: SEMI, CORO or UTI-A, if necessary;
Fill in the system with the Yellow Code Registration form.
Adult
Notify the patient's doctor about the activation,
evaluation and conduct.

The doctor attending to the yellow code should wear a private uniform during the shift.

The transportation request for transfers must be requested at extension 78528.

Pediatric Urgencies and Emergencies according to established criteria

specific documentation is met by the Pediatric Yellow Code.
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Obstetric Emergencies and Urgencies according to established criteria in
specific documentation is provided by the Yellow Obstetric Code.
Advanced external units follow established service criteria.
specific documentation for emergency and urgent care.
Urgencies and Emergencies for passersby according to established criteria in
specific documentation is covered by the Orange Code.

CORRELATION WITH LEGISLATION AND GOVERNMENT REGULATION

N/A

QUALITY AND PERFORMANCE INDICATORS

Indicators
Interval between the activation and the arrival of the code at the unit;

Patient transfer rate to the ICU;

Activation rate for patients in terminal condition.

ANNEXES

RECORDS
In nursing notes and evolution. In medical evolution and prescription. The Record of
Yellow Code Adults also does so in its own printed format available in the medical record
Electronic, the filling out should be started by the local team and completed by the nurse.
You are the responsible doctor for the care.
In case of system downtime, the paper form must be filled out, the white copy
delivered to the ICU secretary and the colored one filed in the patient's physical record.
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BIBLIOGRAPHIC REFERENCES

. Vandegrift MA, Granata R, Totten VY, Kellett J, Sebat F. Review of 20 Years of Continuous
Quality Improvement of a Rapid Response System, at Four Institutions, to Identify Key Process
Responsible for Its Success. Crit Care Explor. 2021;3(8):e0448. Published 2021 Aug 10.
doi:10.1097/CCE.0000000000000448

. Higashino M, Hiraoka E, Kudo Y, et al. Role of a rapid response system and code status
discussion as determinants of prognosis for critical inpatients: An observational study in a
Japanese urban hospital. Medicine (Baltimore). 2021;100(32):e26856.
doi:10.1097/MD.0000000000026856

. Lyons PG, Edelson DP, Churpek MM. Rapid response systems. Resuscitation. 2018;128:191-
197. doi:10.1016/[Link].2018.05.013

. Moreira AAS, Ramos RO, Ligório ABS, Junqueira KD, Corrêa KS. Rapid response team: what
factors interfere with your performance?. Invest Educ Enferm.
2018;36(2):10.17533/[Link].v36n2e05. doi:10.17533/[Link].v36n2e05

. Maharaj R, Raffaele I, Wendon J. Rapid response systems: a systematic review and meta-
analysis. Crit Care. 2015;19(1):254. Published 2015 Jun 12. doi:10.1186/s13054-015-0973-y

. British Columbia Ministry of Health Services. Standardized hospital color codes of British
Columbia. Available in [Link]

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safe/health-emergency-response/[Link]; 2011 accessed in
02/02/2018

. Waldo, D. Standardization of emergency code calls in Oregon. Available at:

[Link] accessed in 2009
02/02/2018

. Institute for Healthcare Improvement, 100,000 Lives Campaign and 5 Million Lives Campaign.

. Joint Commission International Accreditation Standards for Hospitals Manual - 7th

Edition

RELATED DOCUMENTS

Document Title

Cardiopulmonary_Resuscitation_Code_Blue_Service

Pediatric Cardio-Respiratory Arrest Care Blue Code Pediatric

Emergency care, complications, and medical assessments of pediatric patients at HIAE-Morumbi

Pediatric Yellow Code

Emergency, Urgent, Incidents and Medical Evaluations of Obstetric Patients at HIAE

Morumbi - Yellow Obstetric Code

Activation of the AVC code

Attention to Psychiatric Disorders or Severe Behavioral Disorders at HIAE

Emergency, Urgency, Intercurrences and Surgical Evaluations of Patients at HIAE -

Morumbi - Surgical Code.

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Yellow Code Adult Morumbi
Adult and Pediatric Fall Prevention Protocol

Emergency and Urgent Care for Passersby at the Morumbi Unit: HIAE and Surroundings (Code L
orange

SUMMARY DESCRIPTION OF THE REVIEW

Adriana Serra Cypriano (11/05/2014 11:02:07 AM) - Document updated by Michele Jaures

Michele Jaures (09/05/2017 04:41:43 PM) - Update of the recording method in the medical record
electronic and use of contingency in case of CERNER system downtime.

Michele Jaures (04/05/2018 12:22:14 PM) - Update of the code triggering format
surgical and inclusion of the use of specific uniform for the doctor who attends to the code

Michele Jaures (10/02/2018 12:45:13 PM) - Inclusion of the MEWS criterion >= 6 for activation
of the yellow code

Michele Jaures (02/15/2021 03:42:44 PM) - Review of the Joint Accreditation Standards
International Commission for Hospitals according to the update of the 7th Edition without change of
content

Michele Jaures (09/08/2021 03:24:24 PM) - Formatting and typing adjustments were made.
Corrected content of CORRELATION WITH LEGISLATION AND GOVERNMENT REGULATION and
transferred to BIBLIOGRAPHIC REFERENCES Inserted contact of the reference physiotherapy of the UTIA
for support in the wings that this professional is not

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