ACLS requires a doctor's order?

[BUNightingale]

My facility is telling us that we must have a physician's order to start pushing ACLS drugs. They are telling us that it is a violation of the Nurse Practice Act to start ACLS without an order and that we are operating outside of our scope of practice because we are administering meds without an MD order. We have, in the past, just paged the MDs and started ACLS with high quality CPR, pushing whatever meds the patient's condition called for, following the algorithm. I work in a large teaching facility so there is always an MD somewhere close by so this problem isn't really that important specifically to me but what do smaller hospitals do when there isn't a doctor handy? Has anyone else ever heard of this? What do we need certification for if we can't do it without an order? Wouldn't any RN be able to administer these drugs with a physician present?

[CVmursenary]

I think a any nurse should initiate ALS if aware of algorithms and situation. I think saving a life is more important than not doing anything and worrying about legal situations. Should be a good Samaritan law regarding proper ACLS attempts.

[buncee]

That is the whole point of being ACLS certified, to begin ACLS treatment if you are the first to respond. Paramedics aren't Doctors, but they can administer medications without a doctors order.

[ICU4U]

its bull.. your covered by your hospital policy and your advance cardiac standing... your certified.. and you can push the drugs

[ICU4U]

its bull.. your covered by your hospital policy and your advance cardiac standing... your certified.. and you can push the drugs

[HyperTension]

I just can't help myself on this... ::sorry people::

ACLS has successfully recovered this post... Granted, pupils are F&D, no gag, no blink, maxed pressors, and just started epi... "just because".. OH, and the floor just called... the found the missing DNR paperwork.. :)

[brainkandy87]

I'd refuse to work in a hospital that didn't have a policy concerning ACLS protocols. That's a dangerous situation for a nurse. If you have a code and start pushing drugs per ACLS protocol without a physician present, you're in trouble. If you have a code and you don't do ACLS protocols, you're in trouble.

[TraumaSurfer]

That is the whole point of being ACLS certified, to begin ACLS treatment if you are the first to respond. Paramedics aren't Doctors, but they can administer medications without a doctors order.

Negative. Paramedics have written standing orders called protocols. They must work under a Medical Director who determines what they can and can not do.

This is no different than what a nurse has with standing orders on the floor or in the unit. Code Teams and Rapid Response teams also have their standing orders signed by the physician overseeing those teams.

ACLS is barely worth the paper it is written on these days. Anyone can take the course if they meet the minimum entry requirements for ECG recognition and work in some are where a person might code. This includes licensed, certified or just assistive personnel. It grants you nothing in the way of scope of practice set by your profession, state or facility. Your facility might require it as a way to meet some job description but should not replace protocols or education provided by your facility. Years ago it was an achievement to pass this course and employers could be fairly confident you were capable of providing ACLS as a competent provider. Now if you can sign your name on the card you will get one.

Several places don't even require their nurses or other code team members to have the AHA ACLS. They have their own competency training in place or offer their own form of it. UCSD's ART/BART Resuscitation program is an example.

[PMFB-RN, RN]

ACLS is barely worth the paper it is written on these days. Anyone can take the course if they meet the minimum entry requirements for ECG recognition and work in some are where a person might code. This includes licensed, certified or just assistive personnel.

*** Thatnk you! I thought I was the only one who thought ACLS had been seriously watered down. Not long ago there was a discussion about this here on AN and most disagreed with me. Remember when people used to FAIL ACLS? Nobody fails in our system anymore.

[Iseeyou_RN, RN]

Seems simple to me. Code status is addressed on admission by the physician, he or she write the order for full code, DNR/DNI etc. If the doc writes full code isn't that an order to code the patient if they arrest?

[TraumaSurfer]

Seems simple to me. Code status is addressed on admission by the physician, he or she write the order for full code, DNR/DNI etc. If the doc writes full code isn't that an order to code the patient if they arrest?

That holds true that a Code can be called and a code team with ICU RNs to push drugs and an RT to intubate with maybe a doctor to oversee the code.

But, just about anyone can take ACLS. This includes Respiratory Therapists, Radiology Technologists, Exercise Physiologists, PCTs who work on a tele floor, med surg RNs etc. Are all of them equally qualified to crack open the crash cart and start pushing meds? In some cases they are but the ACLS cert itself does not give them that ability.

What about the intubation part? I have heard of RNs who have been severely disciplined not only by their facility but also by the state for jumping in an attempting to intubate claiming ACLS gave them that right. This is why the AHA has put a statement at the beginning of their textbook that the class does not grant you a new scope of practice or supercede the policies of your facility. All ACLS instructors should also be enforcing that in each class.

[brainkandy87]

I have heard of RNs who have been severely disciplined not only by their facility but also by the state for jumping in an attempting to intubate claiming ACLS gave them that right.

What is wrong with some people?

[LilygirlRN]

I am an RN ACLS provider/instructor at a large campus with subacute services. The acute care facility is across town. I'm on the front line in triaging and managing unexpected cardiac and neuro emergencies in an apparently healthy but high risk ambulatory setting (we stabilize and call 911). I don't have physician back up in an emergency or a code. Although there are physicians on the wards and in the clinics in other buildings. The institution has decided that a physician does not have to respond to a rapid response call or a code on our campus. There is a push to get the nurse managers ACLS certified here. Where does that leave me in an emergency? Am I allowed to push ACLS drugs per algorithm? Our medical director says yes - as long as we do it correctly (he is at the other campus). I have read our hospital policies, reviewed our state's nurse practice act (didn't address this type of thing), and briefly looked at ANA Scope of Practice (it looks like a text book). But I'm still unclear about my role and responsibilities and worry about the position I am being placed in. Can anyone help? I'm thinking of consulting an attorney. I don't feel communication is good at this institution at all.