Coding patient in LTC

CoffeeRTC, BSN, RN · Sep 15, 2011

You probably have a P and P for this but at the very least.....verify code status. Call for help...even if it is a CNA, housekeeping etc..tell them to call 911. If you have a "crash cart" have someone get that while you start CPR.

LTC "crash cart" is not like acute care. Some places may or may not have a cart set up for emergencies. We have items like O2 tank with the mask/ tubing ready to go, ambu bag ready, CPR board, suction machine with tubing etc (alot of chocking incidents) some places may have an AED. Learn what yours has and who checks it and how often.

itthybitthythpider · Sep 15, 2011

Definitely verify code status. If the resident is full code or wants CPR, then start CPR and call 911. If the resident is a no code, Attempt a set of VS, then report that you were unable to get the vitals, can't hear a heart beat, and can't hear lung sounds.

username33 · Sep 16, 2011

Thank you!!!

tewdles, RN · Sep 16, 2011

Follow your facility's policy.

911 and BLS...notify family.

brhamlin · Sep 17, 2011

Like we say " When in doubt, ship them out!" Take good notes on whatever you can write on (i.e. time CPR started, who is doing what, what time ambulance took over, when was O2 started?) remember to look at the big picture.....did they have any funky labs? Hx of CHF/Cardiac issues?, a new narcotic? Look for reversible causes - you will do great!

DixieRedHead, ASN, RN · Oct 7, 2011

First of all, I agree with all of the above. I would like to tell you one thing that I have found that my nurses were absolutely unaware of. When you hook that 02 tank up to the ambubag, for crying out loud, turn it wide open. I don't care if they were on two liters, or if they have COPD. They are dead, give them as much 02 as you can get in them. Do your BLS, and always alway always call for a scribe. You need to document exactly what time everything happened, when the patient was found down, what condition they were in, and any response or lack thereof. Chart what time EMS arrived, and what time the resident left the facility.

PammyRN,CEN · Oct 8, 2011

If their code status is full code you must start CPR notify 911 that you have someone in cardiac /cardiopulmonary arrest AND CPR is in progress. Even if it appears that they are very dead you must start CPR. Some facilities have received Immediate Jeopardies because nurses did not start CPR upon finding someone who was a full code. This is very bad for you and the facility. Read your policy well. Some policies state that someone remains with the patient, a facility was cited because staff did not start CPR and they dud nit follow policy on starting CPR nor did they have the nurse stay with the patient. Know who on your assignment is a full code make knowing this a priority for your daily practice. Ensure you know that the crash cart is ready to go on your shift! I have entered a facility and began checking crash carts and the first one took me an hour to clean and then oxygen didn't work went thru 2 tanks before getting it to work. No yaunkers or French sx caths on cart. know where stuff is and ensure it works!

PammyRN,CEN · Oct 8, 2011

Ask 911 what time their strip says if they call the code at the facility, this will be the time of death. In ltc we are only allowed to document that their is no bp, pulse or respirations usually validated by 2 nurses. Remember scope of practice!

CapeCodMermaid, RN · Oct 8, 2011

Every state has different regulations about CPR in the long term care setting. Two or three years ago, Massachusetts revised the regulation so now we don't have to start CPR if there has been a decapitation. No, I am not making this up. Prior to this I guess they expected us to start CPR on the headless horseman!

montecarlo64, ASN, BSN, LPN · Oct 11, 2011

Too funny!! That would also be a state reportable I'm guessing!

Racklebrown · Nov 6, 2011

I am new RN in LTC. What are my responsibilities during code blue ( heart or respiration stopping)?
Thanks!

The best thing you can do in LTC (in almost every situation) is find out who your best CNA's are!! When you find yourself in a code, they will be the ones running to grab the chart with the code status. They will always know where the crash cart is hiding (no matter how many times it has been moved). They are the ones that you will be leaning on.

As far as, RN to LPN responsibility, the RN is always technically in charge, unless the Policy and Procedure manual CLEARLY states otherwise. In most facilities that means you are one person for all 300 or more patients. You will find LPNs that will run their own still, every nurse available should go to each one. But If you see something going wrong, you have to let them know it's your show. You and that floor nurse will take the heat together if there are problems. I would also talk to your DON and Admin, make sure everyone is on the same page. If it is somehow not your responsibility, make sure you copy that P&P page and keep it for yourself. I have seen those things disappear and completely change overnight when something goes haywire! Always CYA!!