Codes

[applesxoranges, BSN, RN]

Ok, maybe I am just burned out but I am seriously annoyed at how codes are run at this one facility that I work at. It feels disorganized and almost unsafe.

1. Everyone has to run into the room. OMG! Seriously. Every RN in the ER (about 7) decided they had to be in the room. We still have about 18 patients in the main floor so I stayed out. This is plus doctor and 2 respiratory therapists.

2. The two techs were walking around the main ER and I made a comment about why was every RN in the code room. They said "they need them all in there" and started listing off jobs." I pointed out that usually in most facilities techs do compressions. Their defense was "he did a round." Seriously? Also, other facilities I've worked in we have rotated people into the code to give people a break. Think about it, even if it was just one tech in there and the other stayed on the main floor then that would have been 1 more nurse that would have been on the floor.

3. In a facility where there is a cath lab and we ice them frequently, we may have that many people in the room to help set up with the ice stuff. The cardiac ICU nurses usually run the drips and the machines. However, that is usually 4 nurses, a doctor, and the charge nurse or house sup acting as a runner.

4. We don't get codes in the ER frequently. I think of four since I've worked here which leads to a "omg! I want to do compressions."

My issue is that it doesn't feel like the codes are efficient or properly utilizing resources. The main ER does not stop because there is a code.

We've run codes with less people at other facilities. The chest compressors do not have to be RNs although the RNs should rotate in to help prevent fatigue. Maybe it is also a combination of EMS where we have knocked down the roles a lot less than what it used to be.

What are your thoughts? How are codes run in your department?

[Lunah, MSN, RN]

That sounds like a hot mess in need of a performance improvement project. I nominate you! Why not do some research on the efficacy of established code teams with defined/assigned roles and present it to management?

The first thing the RN who "owns" that room needs to do is learn how to do crowd control, or the charge nurse needs to be the sentry. I am known for telling people to get out if they are not part of the resuscitation. I don't care who you are (and in the Army your rank didn't matter) — if you're in the room without an assignment, you're in the way. We typically assigned roles at the beginning of each shift based on who was present on shift. IV/meds, monitor, recorder, airway (docs), etc.

I remember attending a lecture at a convention — I think it was an ENA thing — in which an RN talked about designated roles in codes, and their facility actually gave lanyards to the code team. Each role was embroidered on each lanyard, and you weren't getting in the room without a lanyard. Each role was fully trained — for example, if you were the monitor person, you were an expert with that monitor. Helped cut down on the duplication of efforts and overcrowding. This was for a hospital-wide code team, but the concepts could apply to codes in the ED as well.

[emtb2rn, BSN, RN, EMT-B]

We use the standard acls protocol. Primary writes, 1 rn pulls drugs/does electricity, 1 rn pushes drugs/is hands on the pt, 2 techs who rotate compressions, if going for long, we rotate techs altogether. 1 doc, 1 rt.

[applesxoranges, BSN, RN]

Yeah, I am actually thinking of switching my capstone to a quality improvement project based on what I saw yesterday. I work in several hospitals and so I get the joy of seeing how it is done from multiple facilities. Some of the people haven't worked other facilities in a long time or this has been their only ER job.

I still am amazed that the techs weren't in there and the one's excuse "he did a round" is acceptable. Um, when I do compressions I usually do multiple rounds since we rotate. I was a previous ER paramedic at a different facility too. To be fair, we don't get codes here very often so a lot of the nurses are like "omg! code! I want to be in there! I want to show I am strong and do compressions!"

To be fair, most cardiac arrests don't come here due to the unique situation of the city of where you can throw a stone and hit another hospital (we should not have as many hospitals as we do for a city this size but somehow they make it work). Also, the county has protocols where they can call them in the field after X amount of time.

I am planning on talking to my professor today and then hopefully talking to my manager and educator tomorrow about the proposed project.

[Bobjohnny]

I've noticed that crowd control during codes (& traumas) are an issue at both facilities Where I've worked in the ED. However, at one facility charges & staff were empowered to kick unnecessary people out.

I'm thinking that I'm going to bring this up at either (or both) our next Charge nurse meeting or staff meeting.

[Lunah, MSN, RN]

To be fair, we don't get codes here very often so a lot of the nurses are like "omg! code! I want to be in there! I want to show I am strong and do compressions!"

In Afghanistan, we had a red line on the floor in my trauma bays. Nonessential peeps had to be behind the line, period. That was kind of the wild west of trauma nursing, but if your room is big enough to allow students/onlookers/people who need to watch and learn, a line on the floor works well. It gives concrete parameters and really gives your charge nurses leverage to direct traffic.

Good luck on your project, it sounds like it will be beneficial on many levels! :)

[traumaRUs, MSN, APRN]

I worked level one trauma center where running two codes simultaneously was routine. We used a Lucas device for compressions (came from pre-hospital) so no need for a person, we had two RNs, one or maybe two docs, an RT, xray came and went, chaplain, tech for runner and that was it.

[Nalon1 RN/EMT-P, BSN, RN]

Unless the code is my room, I seldom go in unless they are short. I have done enough codes in my life as a paramedic, I could be happy if I never did another.

Last night there was a code, 4 nurses, MD, 2 techs, pharmacist and RT in the room. Me, another "well seasoned" nurse (ie, about to retire with 30 years) and a tech who has about 6 years as a paramedic on a 911 truck stayed out and took care of the other 15+ patients for an hour or so. Nice and quiet in that ER except by the major room.

[Maevish, ASN, RN]

Ok, maybe I am just burned out but I am seriously annoyed at how codes are run at this one facility that I work at. It feels disorganized and almost unsafe.

1. Everyone has to run into the room. OMG! Seriously. Every RN in the ER (about 7) decided they had to be in the room. We still have about 18 patients in the main floor so I stayed out. This is plus doctor and 2 respiratory therapists.

2. The two techs were walking around the main ER and I made a comment about why was every RN in the code room. They said "they need them all in there" and started listing off jobs." I pointed out that usually in most facilities techs do compressions. Their defense was "he did a round." Seriously? Also, other facilities I've worked in we have rotated people into the code to give people a break. Think about it, even if it was just one tech in there and the other stayed on the main floor then that would have been 1 more nurse that would have been on the floor.

3. In a facility where there is a cath lab and we ice them frequently, we may have that many people in the room to help set up with the ice stuff. The cardiac ICU nurses usually run the drips and the machines. However, that is usually 4 nurses, a doctor, and the charge nurse or house sup acting as a runner.

4. We don't get codes in the ER frequently. I think of four since I've worked here which leads to a "omg! I want to do compressions."

My issue is that it doesn't feel like the codes are efficient or properly utilizing resources. The main ER does not stop because there is a code.

We've run codes with less people at other facilities. The chest compressors do not have to be RNs although the RNs should rotate in to help prevent fatigue. Maybe it is also a combination of EMS where we have knocked down the roles a lot less than what it used to be.

What are your thoughts? How are codes run in your department?

Good grief! That does seem stupid (I was gonna say "silly", but no, it's stupid). That's how codes are run at a lot of places, but most of the time, when that happens, the house super will dismiss people after awhile (leaving 1-2 extra people for compression relief). It's the natural thing to do, when a code is called, to run in the room, especially if the hospital doesn't have a set routine/procedure in place. Once you've found out that you're not needed though, you should move on without someone having to tell you (like you did in your example).

Some hospitals I've been to assign certain people to certain tasks, on the off chance someone codes, during the shift assignment and that's really nice (although if someone else's pt crumps it has to be rearranged a bit). It makes for less chaos, but lets other people run for them (outside the room!) if necessary. That's all I did for two codes at that facility: mix levo, mix vaso, communicate with pharmacy, prime CVP, ART, and PAP lines, label the tubing, get orders, etc.

Hopefully they'll figure that out where you work and it never hurts to mention it to the director/manager because, even if it's not something that you do very often, there should be a protocol in place that actually gets followed.

xo

[Maevish, ASN, RN]

I worked level one trauma center where running two codes simultaneously was routine. We used a Lucas device for compressions (came from pre-hospital) so no need for a person, we had two RNs, one or maybe two docs, an RT, xray came and went, chaplain, tech for runner and that was it.

OMG the Lucas device!!!! #heaven:saint:

[NurseOnAMotorcycle, ASN, RN]

We have a "box" painted on the floor with circles for essential personnel to stand at (provider, RT, person doing CPR, med nurse, recording nurse, etc). If you are not one of those people you stay OUT of the box even if you are lining up to do CPR.

[360jRN]

Sounds like how codes on day shift at my facility are run. They actually page them over head and that brings down every nosey Nancy "to help". When you've got scrub techs and your CEO in the corner of the room - somethings wrong. And that's just one more reason I work nights