Code Blue in LTC

[SaraO'Hara]

Yesterday, one of our full code residents was found unresponsive and apneic. Code Blue was paged overhead; from what I've been hearing, there was a lot of confusion about who should do what during the code. Apparently the crash cart wasn't well organised either. My facility's procedure is to provide BLS and call paramedics.

For those of you who work or have worked in LTC, how did you run your codes? Were there different roles, eg first on scene positions backboard, opens airway, starts compressions, second ventilates, third calls 911, anybody else records or gophers?

[CapeCodMermaid, RN]

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..."

[IowaKaren]

I guess during CPR class, no breath means no pulse. We don't check for pulses anymore when initiating CPR and someone has called 911 along with retrieving the AED. Anyway, if they're going south fast, we will do what it takes if full code or not (no code, no CPR) but will call family, then 911 if they want for no codes. If we walk into the room and they are dead (no pulse, no repir's), we don't do anything if they are a full code. That's what I was told by my superiors and will take a look at the P & P Monday night when I go back to work.

[CoffeeRTC, BSN, RN]

This is a very real issue that I try to bring up at work. A lot of our residents have been getting younger and sicker (when they are admitted) In the past, we might have only had 1 or 2 full codes out of 50 pts. Now there are 10-15 or more!

I am very confident in our EMS response time...5 minutes max from time of call till they touch the pt. The PP that stated they are over 15 mintues....I'm guessing you have to be very rural? Even with a great EMS response time, it still matters what you do for those 5 minutes.

[celestial1]

This subject has been on my mind for some time now probably because I started helping out on the midnight shift. We have 60 residents. Most of the time at night it is one LPN and two CNAs. However our CNAs are not required to be CPR certified. We have in reality no crash cart and I could not tell you when the last time our facility ran a code drill. I mentioned that to my mom and she said that it is probably because if they ran the drill then they would see that due to be short staffed no one would know what they should be doing.

[Paulann]

I do have to say that I am a little rattled myself. I am a new nurse, who just two hours ago had her first code. It was a nightmare. Mainly because of the other 5 nurses that were there and flocked to the room. No one brought the crash cart, no one yelled anything about a code, i had to figure it out and quickly call 911 and get that ball rolling. I was terrified, not that I let it show!, BUT all those seasoned nurses only one seemed to be doing something constructive. I may be new at this but one piece of advice, this patient is still a person, and most likely terrified on their own, talk to them while you work I honestly managed to help her that way in some small way while we awaited the ambulance. I will be in the admins office tomorrow morning convincing her to run mock codes, I will never be that unprepared again.

btw thanks guys, all your posts really help me to not feel like I failed tonight.

[debRN0417]

I guess during CPR class, no breath means no pulse. We don't check for pulses anymore when initiating CPR and someone has called 911 along with retrieving the AED. Anyway, if they're going south fast, we will do what it takes if full code or not (no code, no CPR) but will call family, then 911 if they want for no codes. If we walk into the room and they are dead (no pulse, no repir's), we don't do anything if they are a full code. That's what I was told by my superiors and will take a look at the P & P Monday night when I go back to work.

There have been deficiencies at harm level and nurses brought before the BON for not initiating a code on a resident who has desired to be a full code. We all know realistically what the story is, however, if a resident wished to be a full code then we MUST honor those wishes.

This is very scary. I cannot imagine coming into a room, finding someone unresponsive, no breathing, no pulse, knowing that they are a full code and not doing anything. Bangle Bangle and Bangle will be knocking on your door with a lawsuit if you're not careful! Needless to stay the state survey agency with a big old ten-day complaint.....

[txspadequeenRN, BSN, RN]

i hate code blues in ltc..but who ever is in charge needs ( or the charge nurse for the patient) to run the code..direct someone to get the crash cart (which generally has nothing on it of use but o2), then direct someone to call 911....there are generally plenty of people to have 2 people at the bedside with the patient one doing compressions one giving breaths....you need to have a cna as a go get person , someone copying the chart and someone at the door to direct the ems to the room. i just started a new job in ltac and they have a code team with people assigned everyday to various positions...recorder, cpr, who is in charge of the code etc.....maybe that is something that needs to be implemented in ltc ..oh and i always have a person whose specific job is to check the dnr status and i don't mean on the report sheet or outside the chart..i mean is there a signed copy in the chart....

[wiley6coyote]

I hope I don't get hate mail over this but I've thought about this alot in my many years in LTC. If you make the most difficult decision to put a loved one in a nursing home- I am talking the truly elderly with advanced dementia etc, why would you insist on making them a full code. I think it should not even be allowed to be a choice.Send them to hospital if you must but to throw an elderly, fragile demented person to the floor, strip them of their clothes, pound on their fragile bones, take away all dignity etc to bring them back for what?? Their quality of life? When a person enters LTC haven't you pretty much accepted that this is the last residence they will ever be in??

We have residents whose families never, ever visit but at the yearly conference they continue to insist that we resusciate Dad even though he is beyond functioning at any level. They can't bring themselves to make that decision even though it would be the kindest one in the world. Just let nature take it's course and allow their loved one to die peacefully when their time comes.

We just recently got a crash board and some assemblance of a crash cart but on nights?? There is only one RN and they are the only one with the key to open the room to get it. How on earth can they possibly do CPR with skeleton staff who cannot leave their areas to help? I think the public needs to be educated on the realities of aging, death and dying with dignity.

[catlvr]

At our facility, we run very few codes (thank the gods!). However, I pretty much begged our staff development coordinator to do a drill, since the ones that we ran were so "fly by the skin of our scrubs". She finally did - six months ago. I really feel that we should do them monthy, for each shift, esp since we are increasing our number of short term patients (more unstable, and most of them full codes). Hospitals have drills, and we should, too. Drives me nuts, because it is so hard as a new nurse to get a hospital position, but that is the place where you learn the most.

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[nurseofalltrades]

I have worked LTC for 5 years. This is how our codes are run....

1st nurse (LPN orRN) on scene takes charge and starts delegating...."U cna go get crash cart" "U other LPN call 911" and so on. The initial charge nurse on scene checks for pulse/breath....if CPR is called for it is begun with or without an RN present. CPR is continued until EMS arrives. Simple

[elprup, BSN, RN]

I started working part time in a LTC/Rehab. My first day I asked where the crash cart was. "Oh it's on the other wing, down at the end of the other LTC hall". My response, "Shouldn't it be at the end of the Rehab hall", (so one doesn't have to run to the other side of the building where they are never going to use it?). Nurse looked puzzled and said Ya.

But, I am new so I have to keep my mouth shut.