Code Blue

Nurses New Nurse

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I'm a new nurse, working on the Med-Surg floor for less than two months, and I've never had a patient code, but am nervous that I won't know what to do when it happens. Sounds silly, but you don't spend a lot of time in school learning how to "run" a code or what's in the crash cart. Any words of advise or website with references??

Specializes in Med/Surg, Academics.
I would advise you to focus your energies on avoiding codes by triggering your Rapid Response team whenever needed. That is a much better goal for your patient population. In order to become really competent/confident in managing codes, you have to work in an environment where they happen regularly enough to give you the experience needed to gain proficiency. This is just should never happen in a MedSurg unit.

Most hospitals have a code team approach, because it is not realistic to have proficient code leaders in all areas (for reasons stated above). Instead, make sure you know what to do first - in order to prepare for the arrival of the code team. This should be spelled out in a policy somewhere. Generally, it involves triggering the alarm, beginning BLS & preparing for the team's arrival (e.g., flat bed, remove headboard, bring cart to bedside, clear traffic, start documentation, etc.) One of the bedside nurse's primary responsiblities is making sure the code team has an fast & accurate H&P on the patient. This process should be covered in a mock code exercise. If there are no mock codes scheduled, talk to your manager to arrange them.

The highlighted is the most crucial in bedside nursing. Open up your policy and procedure manual and look at the examples of appropriate times to call a rapid response. Your hypoglycemia protocol should also have an option, under given circumstances, to call a rapid response. Become familiar with the code cart. Know how to call a code or rapid response.

As the PP stated, you, as the bedside nurse, are responsible for providing patient information to the RRT and code team. This includes code status (and exceptions), current vital signs and trends, reason why the code is called, primary diagnosis and significant co-morbidities, etc. Your co-workers will drop everything (if they can at that moment) and help you. One of them will most likely grab the code cart. The code cart, IV access supplies, bedside FSBS machine, and the chart should be bedside. If not, ask one of your co-workers to retrieve the missing supplies/info.

The rapid response team is not going to ask you any "trick" questions and have confidence that you will know the answers if you have been precepted appropriately. Report gave you all the background and current status as of last rounds. Start of shift vitals should be compared to previous vitals for trends, if possible. Know the abnormal vitals associated with the primary diagnosis and significant co-morbidities. (On my unit, half the patients have "abnormal" BPs, so you're really looking for abnormally abnormal, if that makes any sense!) Know the code status.

I had my first rapid response the second week off orientation, and I had just received report on the patient and was doing my initial shift assessments. To top it off, she was an admit for the previous shift, so we didn't have a whole heck of a lot to go on, trend-wise. The patient was A/O x 4, so she actually helped me with her "normal" s/s of her chronic diagnosis and her vitals. This was definitely an exacerbation of her symptoms and abnormal vitals, and that's the reason the RRT was called. Remember, an alert and oriented patient knows when something is wrong and don't be afraid of asking them questions about what is going on with them, especially if the patient is new to your unit.

And, I can't agree more with what others are saying: YOU ARE NEVER ALONE. Looking back, I'm very glad I had the RRT so early off orientation. I was dreading my first, but the experience made me less fearful of future RRTs (which are bound to happen). BTW, my patient was transferred to a higher level of care, so it also gave me confidence that my gut was right in calling the RRT.

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depends where you work. like others have said the key is to try to prevent codes. you will def not know what to do completely or what needs to be done. i work at a teaching hospital and the 1 code that happened with me working (not my patient) there were about 30 people there within 1 minute or so. in a small community hospital with just the ER dr or one hospitalist and nursing supervisor to come down i can see how it would be a lot scarier.

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Specializes in Emergency/Cath Lab.

I had my first code the other night. Not the first I have ever been to but the first for one of my patients. It happened waiting to transport the person to ICU after I called the RRT. Basically the pt said "I feel like I am going to pass out" and that started the cascade of events. RRT called, doctor called and charge nurse. We had 5 of us in there, the doctor, crash cart and RT. We were just about ready to transfer her when she went down. Talk about the best possible time for her to do that. It was the most fluid code I was ever involved in.

Dont be afraid to use your resources, ever. When I got to that shift, I flat out said I was going to be calling RRT/Code tonight and I told the charge nurse this too. You can just have a feeling about what is going on and dont ignore it. Sometimes it can be right.

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
i work at a teaching hospital and the 1 code that happened with me working (not my patient) there were about 30 people there within 1 minute or so. .

*** OMG! How does anyone get anything done with that many people in the room? I an the RRT RN in my hospital and if that many people came to a code most would be ejected quickly.

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Specializes in Emergency/Cath Lab.
*** OMG! How does anyone get anything done with that many people in the room? I an the RRT RN in my hospital and if that many people came to a code most would be ejected quickly.

It happens at mine too. After its rolling we kick people out. Only way for anything to get done.

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*** OMG! How does anyone get anything done with that many people in the room? I an the RRT RN in my hospital and if that many people came to a code most would be ejected quickly.

i wasn't incolved but am pretty sure that these were just all available drs and people who come down for a look. i am sure they get kicked out of the room as they were just blocking the hallway.

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
It happens at mine too. After its rolling we kick people out. Only way for anything to get done.

*** Do any of these people who are putting the patient at further risk ever face disipline for their actions? I have written up several residents who come to codes to sight see then don't get out of our (code team) way. They usually get in trouble with the chief resident or attendings.

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
I think ACLS is a great start - I disagree that it has become 'watered down' quote]

*** Just curious how long ago did you first take ACLS? When you say you disagree that it has been watered down is this cause the place where you take it is still very rigerous, or cause it was just as easy years ago? How many people in your ACLS classes fail the Mega Code and have to be remediated? How many just failed and did not obtain certification?

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Specializes in Emergency/Cath Lab.
*** Do any of these people who are putting the patient at further risk ever face disipline for their actions? I have written up several residents who come to codes to sight see then don't get out of our (code team) way. They usually get in trouble with the chief resident or attendings.

If they linger after they are told to leave yes they do. We get a lot of students at night so we try to get them to stay and sit in a corner or come do compressions, something to get them to learn a little bit. But all the other people no they are removed. Some like to sit in the hallways, so we just close the door a lot of the time. Some people just like to look and dont do anything ever, they are annoying.

*** Just curious how long ago did you first take ACLS? When you say you disagree that it has been watered down is this cause the place where you take it is still very rigerous, or cause it was just as easy years ago? How many people in your ACLS classes fail the Mega Code and have to be remediated? How many just failed and did not obtain certification?

We actually had 2/14 not pass their mega code. And rightfully so. They couldnt do anything. I dont think the class was that hard but they couldnt answer a single question about meds/rhythms/what to do so they didnt pass. Even the instructors told us it is way easier now.

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Just to throw my two cents into the mix. I don't think ACLS has been "watered" down. What do you mean by that anyways. ACLS is a great place to start. It will help you to learn the algorithms that are used to run codes. When a code is ran, all you are doing is matching the appropriate algorithm to what the patient is presenting with. When a mega-code is mentioned, all that is meant by that is the patient is presenting in a variety of cardiac dysrhythmias, and you change your approach based on which algorithm that you currently need to use. Learning these algorithms by heart, and knowing that nothing will go according to how you think it will, will help you be prepared, remain calm, and to anticipate what will happen next when you do participate in your first code. You can search "megacode" on Youtube for some great videos that show what is going on. Another site that I like is http://www.traumamedic.com for some sims and other fun stuff.

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When did I first take ACLS? 4 weeks ago. I am not a new RN, but I wish I had taken it years ago. My point was that ACLS teaches you the basics. I was encouraging a newer nurse. For those who think it has been "watered down" or "dumbed down," well, I'm sorry. I'm sure you had to hike uphill both ways to get there too.

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just read your post. im new too and had my first rapid response a month off orientation. it was really scary but like others have posted you are never alone. all the nurses on your unit know you are new and will help and teach you just what to do. rapid response and codes are a team effort, you will never be alone when your patient is at such a critical time.

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