Code Training?????

  1. Does anyone know if specialty units offer their new employees some sort of "code protocol"? The last hospital I worked at did not - needless to say there was a code and it was a mess.....noone really knew what their role should be. CPR was initiated, etc., but the pt did not make it. I felt it could have been h andled better. Any input?????What should a new orientee expect in the way of orientation???? Thanks in advance for your info.
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  2. 20 Comments

  3. by   NancyRN
    I've had ACLS but had to BEG to see the contents of a crash cart! I'm certain I'd freeze up during a code. I'd love to have mock codes often ( like a fire drill) so I would feel more confident. Usually so many are in there I just stand out of the way. I think having a code team is a great idea!
  4. by   wsu.rn
    at the previous hospital i worked at, there was a code team: which consisted of icu er nurses docs etc.
    now that i am at a new hospital the code team rotates through staff nursing. i work tele-med surg. i am new to this hospital and have not been on a cocde team bfore. i feel like i am being pushed. if the code pager goes off and my name is on the board i am expected to go. role being either recorder or med nurse.
    i do not feel comfortable first of all i am never been oriented to the code cart or the code team. when i see my name on the board i tell resource i am not comfortable, i would rather go with another nurse a few times. the response i get is you can meet the pt care manager at the code. i have never worked in a hospital that does the code team this way. many mistakes i have heard have been made. i feel like if there was a regular code team of staff that does this repeatedly, codes would run more smoothly. input: how do your hosipitals do this?
  5. by   mattcastens
    We don't have any sort of code "protocol" for our cardiac/respiratory arrests ... the nurses and docs that respond are usually experienced enough to fall into place (except every summer when the new residents appear, then it's a mess for a while).

    We do have a very specific protocol on our unit (cardiovascular ICU) for "heart team STAT" codes -- when we have to emergently crack the chest of a post open heart case. Everyone from the charge nurse to the nursing assistant to the anesthesiologist each has a specific role and place to stand in the room. If you're not part of the team, you don't get to play. We developed our protocol based on the trauma team protocols down in the emergency department.
  6. by   aus nurse
    Things must be a bit different here in Australia!
    Here every new employeee undergoes mandatory BLS CPR. You must also do a mandatory annual competency.
    The training includes a mock setup with Resusi-Annie where you role play your tasks.
    Everywhere I have worked follows this education, both rural and metropolitan.
    I have just commenced at a big metroplitan hospital where this is a code team. Each unit has a crash cart with a semi automatic external defibrillator.....fantastic. Every nurse is trained in it's use.
    The idea is to get defib happening quickly as that first response, with proven better outcomes.
    BLS consists of the first 3 people taking specific responsibility for a task. First is on airway, second is on the SAED, third does the calling for help, then chest compressions if required etc. These people remain with their tasks even when the code team arrives.
    Critical care staff undertake ALS training, again with annual competency evaluation.
    Mandatory CPR training is for every nurse in every unit and updated annually. We have mandatory fire and manual handling annual traing too btw.
    Last edit by aus nurse on Dec 2, '02
  7. by   lisamct
    Although I dont work in an acute medical setting (residential learning disability centre) all our staff are trained in CPR, qualified nurses and nursing assistants, with annual updates.
    And, like aus nurse, we also have mandatory fire safety, evacuation and moving and handling training for all grades of staff.
    Lisa
  8. by   mattcastens
    I think what Gambro was wondering was if other hospitals had a protocol for the response team to follow in order that all responding personel had and knew specific tasks. Certainly every nurse should be at least BLS certified and all critical care personel should be ACLS certified. However, just because you know the algorhythms doesn't mean a code will run smoothly -- you might have two people pushing meds and two trying to interpret rhythms, two or three RTs in the room (one to bag, the others to lend ... I dunno -- emotional support?), not to mention a supervisor, a doc or four, an IV nurse...

    You get the idea.

    With a procedural protocol it can specify exactly who can be in the room to do what. It makes things run a lot smoother.
  9. by   aus nurse
    Ah I see now, Matt, sorry for the misunderstanding.

    I have never been on a code team but yes, ours each have a very specific role. As I mentioned the initial responders stay on their task even when the code team arrives. The code team members have a specific task each, as in venous access, drugs etc. They obviously will take over a from one of the initial responsders if they feel they need to...but it is very much encouraged for the unit staff to remain there rather than being taken over. The whole code is governed by the SAED as it follows a set process of interepting the rhythm and advising shock or compressions.

    Just thought I would add more as I misunderstood, but I obviously am not the one to ask, not being on the team itself. Sorry
  10. by   Gardengal
    The Rns from my ICU go to all codes in the hospital outside of critical care codes. All persons have a pager and the team consists of 2 RNs from our ICU, MDs from different services, respiratory, a transporter, anesthesia of course, and the nurse caring for the patient that day is the recorder.

    We orient our new staff to codes by sending them to all codes occurring during orientation on their shifts. They then go thru ACLS. When they first get off of orientation they do not go to codes, until they are more used to emergencies in the ICU. They restock the cart whan it returns to the ICU after the code so that they learn where things are kept.

    When they begin going to codes they go with someone who has been to many codes....That person hands drugs and supplies from the cart and the new person gives meds, and defibrillates, under the guidance of the other RN. It works out pretty well, except sometimes it's too much of a drain from our unit to send both team members. At times we split coverage with one of the other ICUs so that our patients in the unit aren't shorted. This is a decision based on acuity, if the charge nurse needs to take an assignment and if there are many "road trips" with patients and nurses off of the unit.
  11. by   ACNORN
    All of our RNs and RTs have to have ACLS within the first 6 months of hire (company pays for the ACLS) we also encourage our LPNs to get ACLS and pay them a $500.00 bonus for every time that they get ACLS. Therefore, most are very familiar with the roles and codes. We also open the code cart during orientation so that the new hires can become familiar with the organization. Since I restock the cart frequently after a code and check the contents, I usually man the cart, work the defibrillator , and shock the patient as needed. RT of course bags the patient and assists with the intubation in every code. That leaves a few unassigned roles, but everyone fills in as needed. We are a hospital in a hospital and our host hospital has a code team that responds. I have found that the code is too chaotic when too many people respond. I frequently dismiss people from the code if we have too many people. That has always worked. If there are too many docs in the room giving orders, I ask them who is leading this thing and clearly indicate that only one of them needs to be giving orders. Fortunately this doesn't happen often.

    If your facility is unwilling to open the code cart during orientation (which I think is lame), the best way you can become familiar with the cart is to be the one to restock it after a code. Do that a few times and you will know it like the back of your hand.
  12. by   New CCU RN
    Where I am, we have a code team (one of our CCU RNs, various MDs.... it depends they decide who carries the beeper there are different teams, resp, pharmacist, anesth) When we have an in unit ICU code, we run it ourselves with our MD, pharm, and respiratory. Each of our six ICUs runs their own codes. Our unit sends the RN to codes that are non ICU. Our unit also has a specified code bed.
    As far as ACLS, within the first year our new hires get certified. During orientation they learn mock code stuff and actually a run a mock code along with most of the protocols. They also respond with the code beeper carrier to the in hospital codes. The reason for waiting until around the year mark is that the unit wants to give them time to experience the codes on the unit and really get a feel for them. There is always a lot of support during codes on our unit, we all work as a team. it works well this way.
    As far as being the code beeper carrier, you need ACLS and to be a Clinical Nurse 2 which you apply in between years 1-2 at the hospital.
  13. by   zambezi
    At our hospital, one RN from CCU and one RN from ICU goes to the code, ER RN, ER MD (or any MD really...usually er are the only mds on nights), RT, and Pharmacy goes, as well as one nursing tech. Usually there are lots of people standing by....first code team member is the code leader....nursing tech usually does cpr...team leader delegates med nurse, cpr if tech not there, iv start if needed, procedure nurse, and recorder...all er/icu/ccu rns must be acls cert, everyone else at least bls required...code blue is called overhead on speaker...icu/ccu codes often run internally, occassionally called overhead...chest cracking is handled in ccu rns, though code blue called to get pharm/rts to unit quickly, usually icu sends rn but most often the ccu rns are running the show...most of our crash carts have pictures of drawer contents(photos) hanging from the sides of them, once pharmacy is there, they usually hand out meds...things like amiodarone are not stocked in the cart, pharm brings it...
  14. by   CCL"Babe"
    Any hospital I 've ever worked in the code carts need to be checked at least by the begining of the month, or every shift for expired drugs, equipment, etc. Maybe you could see if you could volunteer for that job. I think it's a JAHCO requirement, because when they were here, they wanted to look at the log for the past ? years.
    I've found that different people seem to "fit" into different roles within the code team, depending on who's there. Most of the team eventually slides into roles they feel most comfortable with. When someone is new it can be awkard at first until they find their role. Some groups of people work together better than others.

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