Code Blue in LTC

From your post, it seems that you should have followed the BLS guidelines provided by AHA. I don't work LTC, but if in your situation, I would have called 911 or for extra assistance and then began chest compressions.

In a lot of the LTC that I have worked, there is no real crash cart. I've tried to get a cart together, but the thinking from above is that the more you have, the more you are resposible for.

Call 911 first. One person stays with the pt and gives the orders...ie. get the cart if you have one, get a board, bag and O2....get compressions started while all of that is being ordered. When more people arrive on the scene, then you can get them to make the family and doc calls, document etc.

Its is really basic call 911 and start compressions etc is the most important.

I'm a former-LTC RN and a field paramedic, so I hope I can give you a unique perspective...

In 13 years as a paramedic, I have never (and I don't use that word lightly) been to a resuscitation-in-progress at any nursing care facility where the efforts were organized. I don't mean "organized" as in 'I could have done better', I mean that there was rarely any cohesion between the staff members who were attempting to revive their resident/patient.

If your facility lacks the ability to work a resuscitation (no defibrillator, few if any code drugs), then the absolute most important thing you can do is to activate EMS as quickly as possible. Doing two minutes of compressions by yourself does your resident/patient absolutely no good if the paramedics aren't on the way.

If you are in a facility or setting where resuscitations are few and far between, I highly recommend that you do two things in order to most appropriately prepare yourself and your coworkers: 1) discuss on a regular basis what you are going to do if you find someone in cardiac arrest (e.g. yell for someone to call 9-1-1, pull the resident to the floor, start CPR). The more you discuss it with yourself and your staff, the more prepared you are going to be. 2) and this is only if you really want to put in the effort to be ready, contact your local fire department about borrowing their rescue mannequin for a few hours and run code-drills. When I started coordinating this at my former facility, the staff (and our local fire and EMS departments) loved it and found it to be great training and practice. You simply put the 180# mannequin in one of your gowns, in bed in an empty room, and you have someone call for help as though it were a real patient. As they enter the room and realize that it's a mannequin, the director/manager coordinating it should then inform them that it is a practice scenario and that they should do exactly as they would for a real patient.

Just a few thoughts for you; if preparedness and efficiency are some of your goals, as they are for any good nurse who cares about his or her patients/residents, you should discuss this with your DON at your next meeting. It's very helpful and, depending on your state, you can even give out CEUs for it.

Thanks

NM78

I've been involved in a few codes in LTC...organized is all relative.

My nurses now look afraid if someone is unresponsive and seem to want to wait until I (the DNS) or the assistant DNS get there. Luckily I'm still young enough to go up 3 flights of stairs quickly!

We decided to start having mock codes to make sure everyone knows the drill. One person yells for help, one calls rescue, one gets the crash cart and one grabs the AED. I was the 'victim' one day and if it had been for real, I'd be dead. People now have a better understanding of the process. I have to say I felt bad because when they saw me on the floor, one of the nurses' aides burst into tears and said "Oh no!!! It's Dorothy!"....nice to know a few of them like me.

PS.Names have been changed to protect the innocent.

When I worked 11-7 shift the codes went well....'cause there was only 2 of us to get it done and we took charge and did it. Our CNAs called 911 while the RN and I did CPR. We had a crash cart, but only with the basics. If we happened to have a third nurse on that night, he would at least get an IV in so the paramedics would already have a line when they got there. But, in all that I've been involved with in LTC, only one got a rhythm back, and he died a few hours later anyway. I just don't think that a code in a 90 year old is going to be successful anyway...at least not for any quality of life.

The thought of a frail, osteoporotic going to code fills me with dread!!An ambulance takes at least 15-20 minutes to get to us and I don't think I could physically do CPR for that length of time! and to what end,smashing up all their ribs etc.

We had a 96 year old who fell and broke his hip,he had his op. and had to be resuscitated in the op.theatre.He was never the same again and died just 2 weeks later.Up until that time he had been an independent man but the last two weeks of his life he was totally dependent on us.Were is the dignity in that?

The thought of a frail, osteoporotic going to code fills me with dread!!An ambulance takes at least 15-20 minutes to get to us and I don't think I could physically do CPR for that length of time! and to what end,smashing up all their ribs etc.

We had a 96 year old who fell and broke his hip,he had his op. and had to be resuscitated in the op.theatre.He was never the same again and died just 2 weeks later.Up until that time he had been an independent man but the last two weeks of his life he was totally dependent on us.Were is the dignity in that?

I agree. That's why 98% of our residents have a DNR signed when they are admitted or shortly thereafter! It should be part of the admission process.

I have worked in a couple of nursing homes and thankfully there was always a crash cart that we had to sign off on each shift.

The most important part of the charge nurse's assignment making each shift was to assign responders in case of a code.

someone (an actual name) was assigned to call ems, do compressions, do ventilations, call the MD, record.

In case of a code, the nearest persons usually performed the immediate tasks, but there is no question who has what responsibility.

Hope that helps

sounds like it's time for an inservice

Unless we saw that last breath, we do not start CPR on our full codes. I just discussed this with my DON and NM during CPR recertification (we were all in the same class). We only have a few of them in the 100 plus residents (mixed with ICF, Alz, SNF) and one nurse is really trying to get them changed and realistically letting the families know the odds of survival, realities of injuries during a code. I don't know why the NM can't help with it but,... I don't know why the admitting coordinator (not a nurse) is asking for code status and have voiced this to the managers. It's not like on TV, bringing them back smiling, good as new. With the elderly, all I've seen with a REAL code is possibly, only possibly bringing them back to only be sent back to us to die.

Have you discussed this practice with yout medical director? If someone is a full code and is 'found without a pulse', CPR is usually initiated. I've never read anything on any consent form which says "If they see me take my last breath..."