Calling codes

[Momma1RN]

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!

[MeiLana]

If it helps, let me reframe it from my POV. During difficult births, the decision to go to c-section is defendable. No one actually gets sued for doing an unnecessary c-section. They get sued for not sectioning when they should (or a myriad other things...but typically not for sectioning and it not being necessary after the fact).

Just calling for eval and RR is not even to the level of doing an unnecessary, but defendable, c-section. No one can say why your charge was reluctant. However, you are the person who gets to go to sleep at night feeling unsure because your charge wasn't 100% on board or feeling regretful for not calling a RR and being swayed against your gut response. If I had to choose, I'd rather go with feeling unsure that my charge didn't support me.

FYI -- that feeling of unsureness is one of the first foundation pieces to the new _you_. When we have to depend on ourselves, even when others aren't supportive of our decision, and then we're positively rewarded with a good outcome -- well, that's a confidence builder and feeds the desire to learn more.

There were times when I knew I was the only one holding the line between good and bad outcomes. I had to get up-close and personal with going to bed full of discomfort and then finding by light of the next day that my decisions still held true the next morning. It really made me develop those critical thinking skills, to be able to defend them with facts and not just be floating along hoping nothing bad ever happened that I wasn't prepared for. Something bad will always happen and you will only ever have the skills you have, the knowledge you have, at that moment and you must use them as best you can. I learned to become accountable for my own education and to drill-drill-drill and constantly be thinking of "What would I do if faced with ?" It makes you a better nurse, a better patient-advocate and a stronger person, IMO, just getting through this day to day business of living that we all have to deal with . :)

[DatMurse]

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.

well it seems like OP has a code stroke which is essentially a rapid response for a stroke patient.

Kind of like code yellow which at my hospital is a combative person.

[MeiLana]

I read it as the equivalent of a rapid response: neuro

[K+MgSO4, BSN]

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.

it depends on the set up of the hospital response systems. Where I work we have a "code stroke" as well - it is local / hospital terminology.

[dah doh, BSN, RN]

My hospital has code blue = dead (full arrest). Code Rapid Response = pretty much everything else including seizure, found down, syncopal episode (including visitors), respiratory distress, hypotension, or ANYTHING the nurse feels is appropriately worried about. If the patient is outside the hospital and is brought in by ambulance for stroke symptoms, it's a Code Stroke. However, if the patient is inpatient, we call a Rapid Response to get the code team doctor to evaluate patient and then activate the stroke team. Same idea, just a different process that bypasses the overhead paging.

[nursephillyphil, BSN, RN]

I'm transitioning to a medical oncology floor after 10 months in a SNF, and i'm not going to lie, calling a code is something i wonder about when i move to acute care. in the SNF i didn't have any issues making the decision to call 911 but we also had to get a Physicians order first. your post just helped me decide to call a code if i see fit. thank you

[Momma1RN, MSN, RN, APRN]

Our docs don't show up to RR. So code stroke is like a RR for neuro- and we get the doc, the IV team and the CT table clear which doesn't all happen for RR. Thanks all so much.

[emtb2rn, BSN, RN, EMT-B]

Time is brain, call the code.

You say ct was negative, was last seen normal within 4 hours of symptom onset? If yes, why was TPA not administered? The contraindication window's pretty small these days, mostly concerning anti-coag therapy.

Bottom line for me, you did the right thing.

[NP2BeNY]

You did the right thing by calling.

In many places, FAMILY MEMBERS are allowed to call for a RR if they are concerned. You are the patient's RN - if you feel the need to make the call go ahead and make the call. As someone else said, you'd rather be called 99 times and not be needed then not be called the one time you were.

[That Guy, BSN, RN, EMT-B]

Yup did the right thing. Get the wheels in motion even if you don't need it down the road. Time is brain!

[Here.I.Stand, BSN, RN]

You were absolutely correct in calling that stroke code. Situations like that are exactly why we have stroke codes! Good job, Nurse!

[Here.I.Stand, BSN, RN]

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.

It's a specific protocol for new-onset stroke sx, distinct from a code blue for cardiac/respiratory arrest