Code Blue

  1. 0 I'm a new nurse, working on the Med-Surg floor for less than two months, and I've never had a patient code, but am nervous that I won't know what to do when it happens. Sounds silly, but you don't spend a lot of time in school learning how to "run" a code or what's in the crash cart. Any words of advise or website with references??
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  3. Visit  newnurseia} profile page

    About newnurseia

    Joined Oct '11; Posts: 2.

    32 Comments so far...

  4. Visit  NickiLaughs} profile page
    1
    Do you have to be acls certified on your unit? Usually if u notice a patient going down, you yell for help. The charge nurse of your unit or designated code team will come & run the code. It completely.depends on your hospitals protocol. I would learn that first. Then update your knowledge as needed.
    Peetz likes this.
  5. Visit  Pixie.RN} profile page
    1
    Have you had ACLS yet? Also, ask your education department about any mock codes that might be scheduled. If your unit doesn't do them, they should.
    Peetz likes this.
  6. Visit  AusRN} profile page
    0
    You won't have to run a code as a first and if you're not advanced life support trained. I'm advanced life support but quite junior, before that I was just scribing, which is a great way to learn how a code is run. As you learn more, you'll recognise when your patient is crashing and hopefully avoid a code altogether, but sometimes that isn't possible. It is scary, your heart beats out of your chest, but if you've got great staff on it's amazing to watch. I work in a high dependancy unit, am advanced life support trained and seen a few code situations in the last month and still am scared.
    Good luck
  7. Visit  newnurseia} profile page
    0
    I'm not ACLS certified yet, but will be in the future. I appreciate all of your advice! It's always nice to hear fellow nurses opinions
  8. Visit  PMFB-RN} profile page
    0
    I doubt getting ACLS certified will make you feel more confident. ACLS has become so watered down as to become almost meaningless.
    Just call for help and begin CPR, in that order.
  9. Visit  HouTx} profile page
    5
    I would advise you to focus your energies on avoiding codes by triggering your Rapid Response team whenever needed. That is a much better goal for your patient population. In order to become really competent/confident in managing codes, you have to work in an environment where they happen regularly enough to give you the experience needed to gain proficiency. This is just should never happen in a MedSurg unit.

    Most hospitals have a code team approach, because it is not realistic to have proficient code leaders in all areas (for reasons stated above). Instead, make sure you know what to do first - in order to prepare for the arrival of the code team. This should be spelled out in a policy somewhere. Generally, it involves triggering the alarm, beginning BLS & preparing for the team's arrival (e.g., flat bed, remove headboard, bring cart to bedside, clear traffic, start documentation, etc.) One of the bedside nurse's primary responsiblities is making sure the code team has an fast & accurate H&P on the patient. This process should be covered in a mock code exercise. If there are no mock codes scheduled, talk to your manager to arrange them.
    CBsMommy, anotherone, dudette10, and 2 others like this.
  10. Visit  turnforthenurseRN} profile page
    0
    First off: you are NEVER alone.

    Second, does your hospital offer ACLS? I would take it as soon as possible. That will get you familiar with the code blue process. And if a patient is coding, call for help and start CPR immediately.
  11. Visit  Ruby Vee} profile page
    1
    Quote from newnurseia
    i'm a new nurse, working on the med-surg floor for less than two months, and i've never had a patient code, but am nervous that i won't know what to do when it happens. sounds silly, but you don't spend a lot of time in school learning how to "run" a code or what's in the crash cart. any words of advise or website with references??
    you're never alone -- there's always someone else there to help you. what you don't remember, someone else will. but as a newbie, i wouldn't expect you to be running the code.
    turnforthenurseRN likes this.
  12. Visit  ~Mi Vida Loca~RN} profile page
    1
    Call for help and start chest compressions. Running mock codes I think do help and if you can get in and watch any codes that will also get you more comfortable with seeing them.
    Trilldayz,RN BSN likes this.
  13. Visit  LogCabinMom} profile page
    1
    I think ACLS is a great start - I disagree that it has become 'watered down' - you really don't get anything about codes in nsg school these days and at least ACLS will introduce you to the meds and the algorithms followed. I think EVERY nurse should be required to take ACLS. Most hospitals, even small ones, run mock codes, so hunt them out - and also try to respond to a code anywhere in the hospital to at least record. Good luck!
    CBsMommy likes this.
  14. Visit  Pixie.RN} profile page
    1
    Quote from LogCabinMom
    I think ACLS is a great start - I disagree that it has become 'watered down'
    I don't know about that, it's changed a lot even since I first took it almost 12 years ago, and even then it was referred to as a "kinder, gentler ACLS." LOL. When did you first take ACLS?
    Skeletor likes this.
  15. Visit  dudette10} profile page
    1
    Quote from HouTx
    I would advise you to focus your energies on avoiding codes by triggering your Rapid Response team whenever needed. That is a much better goal for your patient population. In order to become really competent/confident in managing codes, you have to work in an environment where they happen regularly enough to give you the experience needed to gain proficiency. This is just should never happen in a MedSurg unit.

    Most hospitals have a code team approach, because it is not realistic to have proficient code leaders in all areas (for reasons stated above). Instead, make sure you know what to do first - in order to prepare for the arrival of the code team. This should be spelled out in a policy somewhere. Generally, it involves triggering the alarm, beginning BLS & preparing for the team's arrival (e.g., flat bed, remove headboard, bring cart to bedside, clear traffic, start documentation, etc.) One of the bedside nurse's primary responsiblities is making sure the code team has an fast & accurate H&P on the patient. This process should be covered in a mock code exercise. If there are no mock codes scheduled, talk to your manager to arrange them.
    The highlighted is the most crucial in bedside nursing. Open up your policy and procedure manual and look at the examples of appropriate times to call a rapid response. Your hypoglycemia protocol should also have an option, under given circumstances, to call a rapid response. Become familiar with the code cart. Know how to call a code or rapid response.

    As the PP stated, you, as the bedside nurse, are responsible for providing patient information to the RRT and code team. This includes code status (and exceptions), current vital signs and trends, reason why the code is called, primary diagnosis and significant co-morbidities, etc. Your co-workers will drop everything (if they can at that moment) and help you. One of them will most likely grab the code cart. The code cart, IV access supplies, bedside FSBS machine, and the chart should be bedside. If not, ask one of your co-workers to retrieve the missing supplies/info.

    The rapid response team is not going to ask you any "trick" questions and have confidence that you will know the answers if you have been precepted appropriately. Report gave you all the background and current status as of last rounds. Start of shift vitals should be compared to previous vitals for trends, if possible. Know the abnormal vitals associated with the primary diagnosis and significant co-morbidities. (On my unit, half the patients have "abnormal" BPs, so you're really looking for abnormally abnormal, if that makes any sense!) Know the code status.

    I had my first rapid response the second week off orientation, and I had just received report on the patient and was doing my initial shift assessments. To top it off, she was an admit for the previous shift, so we didn't have a whole heck of a lot to go on, trend-wise. The patient was A/O x 4, so she actually helped me with her "normal" s/s of her chronic diagnosis and her vitals. This was definitely an exacerbation of her symptoms and abnormal vitals, and that's the reason the RRT was called. Remember, an alert and oriented patient knows when something is wrong and don't be afraid of asking them questions about what is going on with them, especially if the patient is new to your unit.

    And, I can't agree more with what others are saying: YOU ARE NEVER ALONE. Looking back, I'm very glad I had the RRT so early off orientation. I was dreading my first, but the experience made me less fearful of future RRTs (which are bound to happen). BTW, my patient was transferred to a higher level of care, so it also gave me confidence that my gut was right in calling the RRT.
    anotherone likes this.


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