Managing a Code Grey in Healthcare Facilities

• Nurses and other healthcare personnel deal with a variety of individuals who can be difficult at times and sometimes become agitated, aggressive, and violent.
• A code grey may be called to manage the individual to protect themselves, staff, and others. 
• Learn when to call a code grey, who to call, what team to assemble, and the nurse’s role in the process. 

Editor’s Note: This article was originally published on Sept. 30, 2022, and updated on Aug. 24, 2024.   

What Is a Code Grey?

Nurses and other healthcare personnel deal with a variety of individuals who can be difficult at times, and sometimes become agitated, aggressive, and violent.   

When these behaviors occur, a code grey is typically called to manage the individual(s) in an appropriate manner and ensure the safety of others. Security personnel are typically called to the area to help resolve the situation or remove the individual(s) from the premises if necessary.

 A code grey can also indicate an infant or child abduction, and many of these incidents seem to occur in emergency departments and throughout the healthcare organization.   

Management of a code grey involves activating the code as soon as the event occurs, calling 911 if needed, designating the appropriate personnel, and limiting people in the immediate area to designated staff.

The following are important to fully understand when dealing with a code grey in order to handle the situation safely and effectively:  

• How do you respond to a code grey?  
• What principles should a nurse follow while activating a code grey? 
• Who are the team members involved in a code grey?   
• What is considered a code grey lockdown? 

Responding to a Code Grey

One of the most important principles of medical ethics is allowing a patient to remain independent and respect their body. However, there are times when physical restraint is necessary while responding to a code grey.

Restraint can be warranted when individuals become unsafe and dangerous to themselves and those around them. Physical restraint should only be considered as a last resort, and hospital security or police may be needed.   

If the patient requires urgent medical or psychiatric treatment but has not responded well to other control techniques, physical restraint and/or sedation may also be recommended.   

When a patient or individual becomes aggressive or destructive, the nurse and those present need to act quickly and calla code grey to ensure other patients and staff remain as safe as possible.

Principles for Activating a Code Grey

A code grey should be activated when an individual becomes violent, threatening, or aggressive and creates a health or safety risk.

Once activated, immediate assistance is needed, and those assisting must respond in a timely manner.   

Each healthcare organization should have established policies and standards in place based on the following principles: 

• Support healthy and safe work environments for staff and quality of care for patients 
• Be clinically led and promote safety for staff, patients, and visitors 
• Be based on a risk-assessment approach that is integrated into a broader organizational framework 

The composition, specialized training, and scope of practice needed for a code grey must be pre-determined and documented for each of the principles listed above.  The principles also must be easily accessible and fully understood to be accurately followed and implemented.

Team Members Involved

Code grey team members include: 

• Clinically trained staff  
• Security trained staff   
• Public safety personnel, if needed 
  

The composition of the team must comply with relevant hospital policies and procedures and be consistent with statewide guidance, including the use of seclusion, restraint, weapon searching, and management of any issues pertaining to these factors.

The team members should have pre-designated roles and fully understand these roles to complete a code grey as efficiently and safely as possible. The team members should also ensure that all supplies, such as gloves and goggles, are available when needed.   

The staff initiates the code and should follow a risk-based assessment and protocols set forth by the organization.   

Typically, the code grey team consists of designated staff who are trained to handle certain situations/emergencies that require quick and safe interventions. The events involved in a code grey can become extremely dangerous, but the goal is for team members to react and respond quickly to prevent the event from escalating.   

Code Grey Lockdown

A code grey lockdown occurs when a dangerous person is in the public area, a person is missing, or there is some type of criminal activity taking place in or near the healthcare facility.   

With a lockdown, public safety personnel are responsible for the closing and locking of required doors and/or gates to maintain the safety of all individuals in or near the healthcare facility.   

During a lockdown period, no individual will be allowed to enter or exit the facility until it is deemed safe and necessary.     

The Bottom Line

As with any emergency, the correct and trained personnel acting quickly and efficiently can prevent an event from escalating and provide a safer environment for staff and patients. A code grey team consists of individuals who have been specifically trained in how to respond, what to do, what supplies are needed, what actions to take, and the proper techniques to intervene as quickly as possible when a code grey event arises.

A code grey event can be frightening, but with proper training, supplies, support, and teamwork, the event can hopefully end in a positive way with the safety of both staff and patients maintained.

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