Code Blue-a misapplied procedure - page 3
I'm sure that many of you remember hearing that report of research that showed that on TV, the code blue save rate is something like 90%, but in real life it is much lower than that. TV contributes... Read More
Mar 30, '02Originally posted by Nittlebug
I heard from a doctor that a study done on thrombolytics was skewed to make it look like it was more successful than it really was. You have to read how the study was done before you accept the results as fact and alter your practice.
Questions to ask: Who did the study and do they have anything to gain by skewing the results to make themselves or their product look good?
Perhaps our academic colleagues could chime in here. Tenure in big is granted based on research dollars brought into the institution. Believe me Lilly isn't interested in proving that their new antibiotic has efficacy equal to Amoxicillin; they want pay dirt. even if you have a desire to have a research based practice, it's hard to separate the grain from the chaff.
In my field, drug prevention, I feel the waters are greatly clouded by the need to say that your prevention curriculum is "research based"! We have very respected researchers who are scrabbling to get some financial remuneration from their life's work and we often hear that they tweaked their data to be able to claim "significant impact" on behavior. I also am tired of being told that this curriculum must be implemented with fidelity or you just can't claim our impact (a true statement). While this statement is true, it constitutes "all or nothing" thinking. Most schools do not have room in their academic schedules for elaborate prevention curriculums (especially with schools nearly being held exclusively responsible for student's academic success AND the test, test, test mentality). Most of us just don't work in perfect worlds.
Anyhow, nurses I still feel that we are in a great position to talk with families about the true limited efficacy of a code blue procedure in the elderly, those with a damaged heart, infected, debilitated, etc. Soldier on.
Mar 30, '02Originally posted by aimeee
You hit upon one of my favorite soapboxes, but talking about it here is pretty much preaching to the choir! I deal exclusively with folks who have a terminal diagnosis and you would be surprised how many of them still find it hard to sign a DNR form. One of the hardest things is presenting this realistically while still being gentle.
I think too often people equate DNR with NO CARE and then I think the discussion needs to switch to what care without the impetus to "cure" looks like. The DNR needs kind, considerate CARE.
Mar 30, '02education of patient and families.....regarding advance directives.
getting doc's more involved in the discussion......cause they is supposed to be the ones headin' this discussion
but you know us nurses are the ones......
bringing in pastoral care(to listen.........)(where I am at pastoral care is fantastic)
and then follow whatever the decision is as any good nurse does.....
nursenancy-----I have had a few family balk at the topic.....but they haven't taken offense.....they are just not ready for that thought process yet........
Mar 30, '02The 90% survival rate for a code blue fits in with the average of 12 seconds for delivering a baby, non dripping IV's, a baby born with a diaper on (ER) and my favourite the nasal prong ventilator (wouldn't that be nice?).
Yes it is time to educate the public, and maybe that's what we should concentrate on as nurses. People need to be made aware that there are conditions we can not cure and people do die, no matter how sad it is. In my job I see a lot of people coming for major surgery, while they are with one foot in the grave already. I often wonder why the surgeon puts them through this ordeal, with all the pain and missery. Very often it is the family which demands something is done to save their relative. Maybe it is time we get more grieve councelors in the medical setting to help people with the proces of death and dying.
I have made it very clear to my relatives what I want and don't want if I ever get critically ill, so they have my support in the difficult decission making proces (I hope it is a long time from now).
On a happier note happy easter everybody, hope all is well with you and your loved ones.
Mar 30, '02Marijke,
Perhaps we need to figure out a way to have pre -grief councilors. Try to educate the public before the hard times. During the stressful times it's a lot harder to get the message across. If we could somehow educate before that, as to how much better it could be for all concerned, perhaps we could ease the actual pain and grief. ????
As usual, I have more of a question than an answer.
just my $ .02
Mar 30, '02Yes Ken you are correct, that would be very nice. I have noticed that the attitude towards dying in North America is even more disfunctional than it is in Europe. A lot of families find it unacceptable that grandma is going to die at age 95!!!!!! She was always in such good health and the medical system should fix her or they are going to sue the hospital, the doctors and of course the nurses.
I am not saying we should let 95 year olds die just because they are 95, but on the other hand is it fair to perform big debilitating surgery, to prolong life for 6 months (and their agony?).
We need to educate the general public even before they enter the healthcare system.
On a happier note, today I planted some flowers in my garden, spring is here I hope for all of you out there if you don't have it already, it will arrive soon.
Mar 30, '02There are some really thought provoking comments here and I do agree with most.
Recently read opinions on a board that many feel the new ACLS protocols are dumbed down and may be a little too 'easy', maybe for the sake of just passing people. Of course the AHA makes money on the deal. Also, someone said that a few of the new protocols were not studied enough to be a proven theory, just a theory. Now I have no idea if that is so, but what comes to mind is if indeed most Code Blues are not successful why would one make the ACLS experience as intimidating as it used to be. I personally found my last ACLS class informative, comfortable and not in the least intimidating. What a relief, I had been dreading it. Any comments?
One question - my hospital is initiating a new (to us) DNR/DNI policy. Another words, doctor has to write an order for BOTH or patient CAN be intubated, just not shocked. They are also talking about more specifics on the form - for ex. Do you want vasopressors? (and a whole list of very specific interventions). I think this is WAY over everyones head, they defended their position by saying that it's the DOCTOR who must explain and record in the progress notes AND that it has become a legal issue. Now you and I know the docs aren't going to approach families very often because they are not in the position we are, don't see the family as often as we do, don't get to know individual situations etc. I live in NY. Ever heard of such a thing and what is YOU policy on DNR's?
Mar 31, '02Originally posted by MollyJ
Anyhow, do you think the general public needs to be more aware of this? people, I'm not saying "never" code an old person BUT if families were aware that a code procedure was unlikely to successful and was more likely to de-humanize people in their last moments of life, don't you think they could do more realistic planning and decision-making?
Apr 1, '02presenting it(DNR)accurately and gently without being out of line...........says it all.........
yeouch!!!!!!!!! what is it we do for a living.......we don't just flip burgers here...........
much luv, respect and appreciation to all,