Calling codes

[Momma1RN, MSN, RN, APRN]

I'm a pretty new nurse. I work in a telemetry floor at a community hospital. We are also a stroke center. Called a code stroke on a patient (one I had had three days in a row) the other night for 178/101 BP, sudden onset speech difficulties, headache and right hand numbness. I didn't get in trouble, per say, but the charge nurse (who has been a nurse for decades) was trying to convince me not to call it. She said we should wait for the doctor (we have one doctor in house after 7pm), who had already been paged and not called back after 7-10 minutes. The nursing supervisor and some other nurses on the floor were in agreement that the code should have been called. And turns out the patient got transferred to a higher level of care at another hospital for neuro issues, though his CT was negative that night. Anyone else have similar problems? I don't regret my decision, and would do it again, but i'm just curious how many people have been in this situation, she almost made me second guess myself. Or, if you are a charge who hesitates to call codes, why? Thanks!

[JessicaDanielle]

Having worked on a step down icu/cardiac floor, I always conferred with my charge. If she didn't agree and I still felt strongly, I would indeed call it. It's my license and I would rather feel safer than sorry. If you hadn't called it and the patient were stroking, you would no doubt be the one in more trouble for doing nothing.

[chare]

The purpose of calling a medical response is to get your patient the help they need now, not in 10 minutes when the physician finally answers the page. For this reason, I don't understand the philosophy of having to consult your charge nurse, or anyone else for that matter, before calling any type of rapid response. And I absolutely disagree with calling the physician prior to calling a medical response. You are the one taking care of the patient. If you, not your charge nurse, but you have any concerns whatsoever regarding your patient's condition, call the response. And after you have done so, never second guess yourself for having done so.

At my facility, as PICU charge nurse, I respond to pediatric rapid response. When I arrive, whether I believe that it should have been called or not, I fully support the nurse in having done so as I would rather respond 99 times when it wasn't needed, than not be called the one time that it was.

[AmyRN303, BSN, RN]

Protocol in my facility is to call a rapid if a doc cannot physically be at the bedside in ten minutes. We also call them as needed if there is a change in a patient's condition which may be significant. You did the right thing.

[RN403, BSN, RN]

Agreed, you did the right thing. I would rather call a code and get help then wait around and have something happen to my patient. After all, it is your license on the line and more importantly your patient's health on the line.

[DatMurse]

Its more than just your license. IMO

I am a new nurse as well, but I think its always a good sign to challenge your charge nurse if you have a complete different gut feeling/beliefs... rather than backing down because you are new.

You have had this patient for 3 days straight and recognized a big change in mental status in this patient(Which is why I love working in multiple days straight for stroke patients.. You know the baseline of the patient and is very different.

[Caffeine_IV]

I'm not a charge nurse currently but when I was I did not hesitate to call a rapid response or code. Trust your gut and trust your assessment.

[psu_213, BSN, RN]

First of all, the OP is entirely correct to call the "code." Sudden, severe neurological changes should always precipitate further, immediate evaluation and investigation.

On AN, people often say "I talked to the charge nurse and…" or "If you are unsure, ask the charge nurse." It can be helpful to have another person lay eyes on the patient, but at the end of the day, you are the assigned nurse. If there is a bad outcome, saying "but the charge nurse told me to do ____" is not going to be a valid excuse.

[Guest219794]

"sudden onset speech difficulties, headache and right hand numbness."

I am hoping that you know you did the right thing, and are only asking to feel better about the choice.

I am assuming your "code stroke" triggers a rapid response for a patient who has an acute onset of neuro symptoms. Sudden onset speech difficulties, headache and right hand numbness, for example.

BTW- The whole "it's your license" thing usually comes up in these threads. Nobody lses a license over stuff like this. Continue to do the right thing because it's the right thing to do.

[Farawyn]

Calling a code is not the same as Rapid response. I would have done an RR.

Escalating it in any way was the RIGHT thing to do, however.

[LadyMonteCarlo]

From the description it does not sound like a "code" situation, but rather a urgent response situation. There is a 4 hour window of opportunity for stroke symptoms to be treated with the clot busting drugs. Yes, time is of the essence, but if the patient is not experiencing cardiac or respiratory distress or absence thereof no code situation exists at that moment.

[nrsang97, BSN, RN]

You recognized the change, and responded appropriately. I work rapid response and would rather someone call me, even if I feel it is not needed than not call and should have.

You do not need to need to ask your charge nurse to call a code stroke. You were right to go with your gut.