Code blue on psych floor

elkpark · Oct 18, 2015

I've seen a few codes on psych floors and, I'll tell ya, they've all been ugly (think Keystone Kops ...). As I always tell people, if you're going to fall over dead, don't do it on a psych unit!

Farawyn · Oct 18, 2015

There can be a code anywhere. Sounds like you handled it well, OP.

marshmallowstar, BSN, RN · Oct 18, 2015

I was on the Code Blue team at my psych hospital, Keystone Kops indeed. For the *most* part our nurses are competent, it's more the residents (and sometimes attending psychiatrists) who want to do ALS when we are only BLS certified and have BLS supplies. There is a medical hospital across the street and we call 911 to transfer them.

The biggest calamity of errors I saw was a seizing patient (no known seizure disorder, no known withdraw issues) and the old school attending wanted us to put something in the patients mouth to keep him from biting his tongue, then wanted us to start an IV (which we don't even stock supplies for). Luckily myself and the other nurse were both confident and able to say no and that we were going to follow protocol, the fairly egotistical attending was trying to argue with us while the other nurse and I were rolling the patient on his side, getting suction set up, drawing up IM valium, directing the floor staff to manage the other patients who are starting to escalate, luckily one of my attendings then showed up to the code (it wasn't our unit). The old attending is still yelling at us that we're being "insubordinate", my attending walks up, politely greets the yelling attending and says "Marshmallowstar, what do you need?" I said "An order to administer the valium we just drew up." She gives the order and we get the patient off to the medical hospital but jeez that other attending was quite a distraction and escalated the unit's patients and staff by his behaviors.

Also had a time when a not competent nurse thought a 10 year old boy was having a stroke, was panicking, giving a very poor report to the code team and was ready to send him out 911, however I was able to get out of the patient (not the nurse!) that he had just received his first dose of risperdal 20 minutes prior, never knew that IM benadryl was a cure for stroke

My best advice is to review your emergency policies, your crash cart, expected emergency med dosing and equipment and be the most educated you can be so you can be an advocate for the patient in the moment. Medical codes may not be your comfort zone but remember all your training, you went to nursing school just like the med surg nurses and have the knowledge, it's just making available in times of crisis. Sounds like you did a good job, know that med/surg nurses second guess themselves after codes, especially when a patient doesn't make it. There's no going back, if there's something you would do differently, remember that for next time and move forward.

Does your hospital/unit do debriefings following critical incidents? I've found them to be helpful to get support from peers and often multiple members of the staff are impacted.

Davey Do · Oct 19, 2015

TerpGal! The fact that you did all you could do and continue to evaluate your actions is in no doubt the reason that you are (as your Post history conveys) a good Nurse! We need to keep questioning and examining our actions in order to continue growing in our field.

Thanks to working with LPNs on the floor who give me status reports, we've been able to catch a decompensating Patient, have them assessed by an NP or Hospitalist or Response Team, and shipped off to a Medical Floor. From there, some made it, some didn't.

We did have a Code Blue on the Gero Psych Unit some time ago that came as a surprise... The LPN noted respiratory and cardiac arrest on a Patient with severe dementia during a 15 minute round. We everything did per protocol- initiated CPR, called a Code Blue, crash cart ready, with O2, ambu bag, suction, AED, set up by Psych Nurses, unit doors unlocked with a Sentry standing by... ERP, RT, ICU Nurse readily on hand and, after a adequate attempt, time of death was called.

I've worked probably around a dozen "Code Blues" in my career- from being a first responder on MVAs, as an EMT, as a Nursing Student, in ERs, OR, and in a bog, so I've got a pretty good idea of what is suppose to take place.

The LPN had never been in a Code Blue situation and asked me if that was the way codes were handled. I said yes, everything that took place was pretty much typical. However, since the arrest was not witnessed, the Patient was elderly and had severe dementia, the Code was not as... you know, intense. Nobody was falling over each other and the process was carried out in a rather methodical way.

Julius Seizure · Oct 22, 2015

Don't question yourself. You acted and thats all you can do. I'm sure some nurses would have froze in that circumstance. Your patient had help from you and made it to the ICU. Regardless of the final outcome, you did your job and shouldn't feel any doubt about that.

mtjoanna · Oct 24, 2015

The first code blue I was involved with, as an aid, was disastrous. Pt with blue lips, no pulse; we called and started CPR (not allowed to use the crash cart without the hospital CPR team there). 1-2 minutes later, the hospital operator called us back to ask if this was "for real or just a drill." I believe that my response was somewhat less than professional, but she then immediately called the code blue and alerted the team. Then pharmacy called up and asked if it was "for real." The psych unit was in a different building, so it took a few minutes for everyone to run there, and for security to get to and man all the locked doors along the way. It awful--first time I've ever done CPR. Pt didn't make it. I heard that there was an "educational opportunity" for a couple of the other departments. Next CPR that was called was responded to rather faster.

greenbeanio · Oct 28, 2015

OMG. "Is it for real?"!

How traumatic for you!

Zedrek · Oct 30, 2015

I have been an American Heart BLS for Health Care Providers CPR instructor for 6 years. I have taught many classes and have preformed CPR twice. I would say that I am very competent in it but I can reflect on both codes and see where I could have done better. Having CPR every two years is really not sufficient enough to retain the information. I wouldn't worry about your performance because it's not going to be textbook perfect.