Is there a Doctor in the house? Working a code without one in an LTAC - page 3

I work in a freestanding LTAC and there are times when we have no doctor present. In the case of a patient coding, we are supposed to call the doctor on call for that patient's group, and take orders... Read More

  1. by   KellNY
    Quote from Daytonite
    Doesn't the facility get charged by the city for the use of the EMS services when 911 is called? That might be where the idea of not calling EMS services comes from.
    I could be wrong, but I think the Pt's insurence would cover that (or the pt's family for the copays and whatnot). That's how it's been where I've worked. We had one great son who cursed us out for calling EMS on his mother when she had a FS of 34 and was in a stupor...and a daughter in law who chewed us out over her $50 copay for when we had her mom transported to the ER when she tried to jump out the window and when staff tried to calm her, she tried to stab us with her scissors.
  2. by   traumaRUs
    I guess my biggest concern is what type of care are you suposed to provide these patients? Do they realize they might code and not be transported to the hospital? Do you have the ability to figure out WHY they coded? What type of ICU do you have? Is it free-standing too? Are you able to do ABGs, CXR, CT? My concern is that you might be practicing out of your scope of practice. Good luck.
  3. by   platon20
    Wait a sec, regular RNs have the authority to push epinephrine, dobutamine and the other pressors during a code without a doctor's order? I must have missed that. Usually you need at least a nurse practitioner to order those drugs.

    I didnt know that RNs were certified in ACLS and can run codes on their own with no doc present, including using the defib machine as well as pushing IV pressors.
  4. by   ZippyGBR
    Quote from platon20
    Wait a sec, regular RNs have the authority to push epinephrine, dobutamine and the other pressors during a code without a doctor's order? I must have missed that. Usually you need at least a nurse practitioner to order those drugs.

    I didnt know that RNs were certified in ACLS and can run codes on their own with no doc present, including using the defib machine as well as pushing IV pressors.

    standing orders?

    Patient group directive?

    exemption from medicines legislation for adminstration in life threatening situations (still has to be obtaiend thorugh the proper chain of ordering and against medical direction...)?

    all situatiosn whichg apply here o nthe right hand side of the pond for ALS type drugs

    defibrillation is a skill taught to first aiders ....
  5. by   TazziRN
    No, ACLS. If you're ACLS certified then in the absence of a physician a nurse can order and push the meds as long as they are within the ACLS protocols.

close