Critical Concepts | Hospitals | ICU

Managing a Code Grey in Healthcare Facilities

  • Nurses and other healthcare personnel working on duty deal with a variety of individuals that can be difficult at times and sometimes the individuals become agitated, aggressive, and violent.   
  • A code grey may be called to manage the individual to protect themselves, staff, and others. 
  • Knowing when to call a code grey, who to call, what team to assemble, and the nursing role are all considerations when preparing for a code gray. 

Amy White

RN-MSN – Chief Nursing Officer

September 30, 2022
Simmons University

What Is a Code Grey?

Nurses and other healthcare personnel working on duty deal with a variety of individuals that can be difficult at times and sometimes the individuals become agitated, aggressive, and violent.   

When these behaviors take place, typically a code grey must be called in order to manage the individuals in an appropriate manner and to ensure the safety of others.   

Security personnel are typically called to the area if needed 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.   

The management of a code grey involves activating the code as soon as it 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 for the code to be handled safely and effectively:  

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


code grey call

Responding to a Code Grey

One of the most important principles of medical ethics allows a patient to remain independent and respect one’s body.  As the medical team is fully aware of these principles, there are times when physical restraint is necessary while responding to a code grey.   

The times in which it is warranted include individuals becoming unsafe and dangerous to themselves and when they become a threat to those around them.  Physical restraint should only be considered as a last resort and often, the hospital security or the police may be needed if necessary.   

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 the patient or individual is becoming aggressive or destructive, the nurse and those present need to act in a quick manner by calling a code grey in order to ensure that other patients and staff remain as safe as possible.

Principles for Activating a Code Grey

When an emergency event takes place that may possibly cause actual or potential violent, threatening, or aggressive behavior exhibited by patients or visitors which creates a health and safety risk, a code grey should be activated.   

Once a code grey is activated, immediate assistance is needed, and it is important that those assisting respond in a timely and prompt manner.   

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

  • Must support healthy and safe work environments for staff and quality of care for patients 
  • Must be clinically led and promote safety for staff, patients, and visitors 
  • Must 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 clearly documented in each organization for each of the principles listed above.  The principles also must be easily accessible and fully understood in order to be accurately followed and implemented.

code grey emergency

Team Members Involved

The team members of a code grey team involve the following: 

  • Clinically trained staff members 
  • Security trained staff members  
  • 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 in order for the code grey to be completed as efficiently and safely as possible.  The team members should also ensure that all needed supplies are available such as gloves and goggles when needed.   

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

Typically, the code grey team consists of designated staff that are specifically trained to handle certain situations/emergencies that require intervention as quickly and safely as possible.  The events involved in a code grey can become extremely dangerous but the goal is for the team members to react and respond quickly in an effort to prevent the event from escalating if at all possible.   

Code Grey Lockdown

A code grey lockdown consists of an event in which there is a dangerous person 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, the public safety personnel will be responsible for the closing and locking of required doors and/or gates in the goal of maintaining safety for all individuals present 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 to do so.     

code grey violence

The Bottom Line

As with any emergency, having the correct and trained personnel to act in a quick and efficient manner can prevent an event from escalating and can also 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 in an effort to intervene as quickly as possible when a code grey event is taking place.   

Time is of the essence when an emergency arises and it is necessary that a designated team is knowledgeable and aware of how to act quickly in order to provide safety.  A code grey event can be frightening for many, 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 being maintained.   

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