Code Lavender: Offering Emotional Support Through Holistic Rapid Response

Nurses are familiar with – and many have participated in – Code Blue events to provide resuscitation or immediate medical attention to a patient in need. Hospitals have adopted other color-coded designations, too, for events ranging from bomb threats to child abductions. In 2009, a partnership between holistic nurses and chaplains at Cleveland Clinic led to the first Code Lavender initiative.

“A Code Lavender provides holistic rapid response to emotionally stressful events,” explains Barb Picciano, BSN, RN, HN-BC, Manager of Healing Services. “A trained team responds in the moment when something happens and supports folks emotionally.” The program has grown, with a Code Lavender team of four holistic nurses and 10 chaplains from Cleveland Clinic’s main campus helping more than 1,100 people so far this year. The team is part of the Spiritual Care Department led by the Reverend Amy Greene, DMin.

Immediate support for caregivers

Code Lavender is available to all patients, families and healthcare providers at Cleveland Clinic, though nearly all of the codes have been called to support the latter. The team responds to an average of three to four Code Lavender events monthly, with triggers varying from the unexpected death of a fellow staff member to the emotional after effects of assisting with a Code Blue event.

In 2012, Picciano’s team executed its largest Code Lavender event. Following shootings at Chardon High School in Northeast Ohio, the team provided an enterprisewide Code Lavender for the entire staff of Cleveland Clinic’s Hillcrest Hospital. Several victims of the shooting were transported to Hillcrest, and many staff there had children enrolled at Chardon High. The team served more than 500 employees in a 72-hour time period.

“We are Band-Aid® therapy. We come in when an event happens, ideally within a half hour of the call,” says Picciano. “Our team of holistic nurses and chaplains offers care in the moment, then partners with our Employee Assistance Program and the Wellness Center to provide long-term assistance.”

A broad array of healing tools

Because emotional distress affects everyone so differently, the Code Lavender team utilizes a variety of modalities. These include:

• Manual Therapies – reflexive brushing, light massage, reflexology
• Energy–based Tools – Reiki, Healing Touch™
• Expressive Arts – playing recorded music, singing, self-driven art, journaling, story telling
• Mind–Body Tools – guided imagery, meditation, movement and breathing exercises, acupressure, holistic coaching

Code Lavender is currently offered at Cleveland Clinic’s main campus, Hillcrest Hospital, Fairview Hospital, Medina Hospital and Euclid Hospital. Picciano is working with South Pointe Hospital, Marymount Hospital and Ashtabula County Medical Center to adopt the program.

The holistic rapid response model

While there is no “one-size-fits-all” approach to Code Lavender events, they often have similar elements. Caregivers wear either white lab coats stitched with “Healing Services” or lavender scrubs and carry a lavender storage bin containing supplies to the site. When they arrive on a hospital unit, team members introduce themselves, explain their services and why they were called, and hand out Code Lavender wristbands that serve to remind the healthcare providers that they are being cared for.

Each team member offers services within his or her scope of practice, such as spiritual support from a chaplain or light massage from a nurse. The team sets up one-on-one stations in break rooms for privacy and also walks around the unit offering on-the-floor help. In addition, the team provides information on preventive and ongoing support and hands out things such as aromatherapy inhalers, healthy snacks and water.

Advice for implementing a Code Lavender program

Picciano offers the following advice for other healthcare organizations that would like to implement Code Lavender:

• Conduct an internal assessment – A lot of times, programs already exist to help people that you can build upon.
• Form partnerships – Team with people who can provide the necessary resources, from funding to holistic care treatment.
• Have leadership buy-in – The initiative is likely to fail if leaders and other stakeholders aren’t behind it.
• Sell the program – “You really have to think how Code Lavender fits into your quality and safety initiatives and how it is attached to your mission, vision and values,” says Picciano. “If you’re going to talk to people about starting the Code Lavender program, make sure you use the language they want to hear.”
• Keep data on everything – “We are an outcome, data-driven profession,” says Picciano. Numbers will back up the importance of the program.
• Train your team members – “Have training in place to make sure the people you are recruiting to lead Code Lavender are the right fit for your team,” she says. Picciano is currently revamping Cleveland Clinic’s training to offer eight-hour, customized sessions based on a hospital’s needs.
• Be patient – “Nothing truly sustainable happens overnight,” she says.

The patience of Picciano and her team has ultimately led to a successful Code Lavender program at Cleveland Clinic. As she said in an article in Beginnings magazine, published by the American Holistic Nurses Association, “In a facility that encounters some of the highest acuity patients in the country, we find that Code Lavender provides holistic, rapid response to emotional events in a much needed, appreciated and holistic model of care for our caregivers.”