ACLS requires a doctor's order? - Page 2

This is absolutely correct, ACLS is a certification and not a license to practice medicine. that being said, if you're in a situation where you expect to run the code, you should also expect to have either a patient specific order for ACLS or a blanket protocol covering ACLS for use on patients on your floor or in your purview. A blanket ACLS order could simply be something along the lines of: "follow ACLS algorithms, PRN." The end result would be that you could push ACLS medication or other interventions as necessary at any recommended dosage and you would still be covered under a physician's order to provide that.

As your standing order be something along the lines of "start CPR and call the code team" if you or your floor is not typically in ACLS floor.

Well your hospital is either lying to you or was very selective about the "large hospitals" they contacted. I have worked in several large hospitals in four states and every one had a policy and/or standing orders that not only allowed ACLS certified RN to push code drugs but REQUIRED them to do so when called for. Failing to do so leavs you open for "failure to rescue" charges.
Your hospital administration sounds nasty and out to get you. Is this a Magnet hospital? Sounds like it.

I'd probably ask for the written protocol before taking someones word about this.

Our policy has language stating to follow the appropriate ACLS/PALS algorithm unless otherwise ordered. I cannot comprehend not being able to intervene immediately in an emergency. I hope they don't expect you to withhold defibrillation until specifically ordered if it's indicated.

We are expected to begin CPR/start the ACLS algorithm if a patient codes. Sometimes the hospitalist doesn't respond in a "timely" manner but the ER physician and the rest of the code team usually arrives within minutes and by that time, they are usually the ones directing the code and telling us what to push. If not, it's usually the charge nurse or the nursing supervisor running the code until either the ER physician or on-call physician arrives. Afterwards, the physician(s) sign the code blue sheet, which is your order.

I guess it would depend upon the hosptal's policy and procedures. When I worked the ER, one of us was assigned to in hosptial codes. So was a member of ICU. Both being ACLS certified. When I responded to hospital codes, I would usually "take over" the code and bark out orders (trying to get it organized). We are certifed to run a code without the physician present. Yes, when the MD is present, we would defer to MD (sometimes - you'd be surprised how many have no clue). We aren't going to lose the chance at saving a patient when you have several ACLS certified nurses in the room, RT would manage the airway and intubate, we would monitor the EKG, give epi, atropine, ... per ACLS protocol. If they were a diabetic, we would get a finger stick and if BS was low, and amp of D50 would go in. Well, you get the picture. I won't belabor the point.

Usually, it wasn't an issue, the ER doc would come with me to the code - however, if he/she was already attending a code in the ER or a fresh MI and couldn't break away, it was up to the nurses to run the code.

At our hospital it's a standing order for all MD's. It's even in our policy & procedures. As long as you're certified you are to start algorithms until the MD/code team shows up, which will only be like a half of minute (certain code teams are assigned to certain floors to make it easier). Usually the person who finds the pt unresponsive pushes the code button and starts compressions. Someone else will bring the crash cart and by that time the code team is there to take over. But what's odd is our MD's are not required to be ACLS certified so during a code, they always ask, what's next? Any suggestions? The code team literally does everything. I guess the MD is just there for liabilty issues. lol


Every facility is different. This is something I would get a clear understanding of.

I agree with you. Many of our MD's weren't ACLS certified. I took ACLS classes and recerts with MD's, and boy was it an eye opening experience for me! Talk about dumber than a box of rocks! Mostly, the code team ran the code, even with the MD present - for the reason you stated.

*** At my hospital we have residents who always show up at the codes. Usually too many of them and they are a real nuisance. However they are there to learn, not run the code. We usually allow them to "run" the code with the rapid response nurse or ICU nurse giving them directions when they need it, or if that particular resident of too clueless we don't even allow them to pretend they are running the code. They are handy for pronouncing death when needed.
I am an ACLS instructor and frequently have physicians on our classes. It was an eye opener for me as well. With interns and young residents nobody expects them to know much and it's OK if they are clueless. What is shocking to me is how little attending physicians and senior residents know about ACLS r taking care of sick people. Of course the ER, anesthesia and intensivists docs are superstars but the radiologists, internal med, and surgeons are shockingly helpless.

I am an ACLS Instructor and you must have a doctors order to push any meds, no matter your certification. However, as has been alluded to most hospitals have an Emergency Treatment Protocol that covers you but not all floors opt to use it, more often medical floors. Especially if their nurses are mostly new or a certain percentage are not ACLS certified. So check your protocols to make sure you are covered. Think about it this way if you are on the street and happen to have epi, atropine, an ET tube, manual defibrillator...etc, and someone codes, can you use them? No cuz you don't have an order. Same is true in the hospital.