Code Procedures Please

Blee O'Myacin, BSN, RN · Mar 15, 2006

and then begin your A-B-C's. You shout for help and "someone call 911" because if someone is coding, you are going to need a hospital transfer ASAP and probably someone to intubate on site if you get a viable rhythm.

There should be a written policy on this at your facility. I'd check with your DON.

Blee

suzanne4, RN · Mar 16, 2006

Yell for help, and have someone dial 911. Your facility will not carry the items that are needed for the code such as intubation equipment, etc.

You will need to continue CPR until the ambulance arrives to transport.

But your facility needs to have something in writing as to what you are supposed to do. This should be in the Policies and Procedures Book. And if they do not have one, then they need to put something in place.

Do you have emergency lights in the patient's room to push if you need help that will ring in other parts of the building?

nursebabygurl · Mar 16, 2006

no bells / lights like that

and would I leave to get the crash cart ? I dont even think the aides know where it is .

superbratnurse · Mar 16, 2006

the best thing to do, is check your policy and procedure book, and ask your don.

also ask the other lpn's in the building what procedure is, or the nurse on the previous shift. at least find out where your crash cart is asap!

~brat

CoffeeRTC, BSN, RN · Mar 16, 2006

I think I posted a while back on this subject?

In LTC there is no "codes", or at least they aren't like the ones in acute care. First...next time you work, look around an familiarize yourself with where your supplies are located. O2, cpr mask, ambu bag, back board...these are the basics. Some places might have IV supplies, and oral or nasal airways. Next look for any policy or procedure you have in place.

When you come upon the scene, call for help...for me this would be yelling at the top of my lungs for my cnas to call 911. I would also yell for my other one to get the "cart". I would start CPR. A-B-C. Forget about any paperwork you normally do while transfering the pt out. If they are a full code...that it what you need to be worried about. Not the papers.

Hopefully your EMS has a good response time (ours is under 5 minutes) by the time they arrive you will be glad to hand them over. When EMS comes on the scene...it it their pt. They will do the rest.

Now...my "cart" has O2 with a non repreather mask and an extra (plain line of tubing for a bleed in to an ambu bag. An ambu bag, CPR sheilds, our mini back board, suction machine and all necessary tubing, some basic treatment supplies, goggles and a gown and a tablet and pen for any record keeping.

I started this "cart" about 10 yrs ago when I first started working at this place. I was the 11-7 nurse. 48 pt and 2 cnas.

Another think to do is familiarize yourself with all of your beds and air mattresses and how to disable them if you need to to cpr.

CapeCodMermaid, RN · Mar 19, 2006

1. Holler for help and someone to call 911

2. Get someone to bring the crash cart if you have one....we have one for the whole building kept on the 2nd floor so if you're on the first floor, good luck!

3. Don't forget to assess the basic A-B-C's and start CPR or slap on the AED if you have one.

and 4.....try to ignore the looks of disbelief on the the faces on the EMTs when they come to pick up someone who is brain injured with a gtube and 4 stage 2-3 pressure ulcers from their last stay at the local hospital....it's not OUR decision to have them be a full code with no quality of life.

muncieDON · Mar 26, 2006

All of the information above is totally on the money------however, my concern in LTC is that are we really updating, and checking whether a CPR status is appropriate for out residents. I'm a new DON (old nurse???) but was amazed to find that out of 60 some residents there were at least 15 "full code" residents??? CPR was never meant to jump start a 95 year old heart???? A little unrealistic I think. I've started re-evaluating all residents with the help of their physicians, families, social services, etc to get these records updated and explained. We recently had just this situation---with a CPR pt being found unresponsive, and obviously dead-------CNA's talked that he should have had CPR---(like they would know how to do it) and before it was done, we had state surveyors in the building on a complaint??? All has turned out well, and we do have new policies in the works. During this process I've learned alot, but DON's across the board need to be VERY INVOLVED in Advance directives----making sure they're updated------and knowing the laws in your state!!!!

CapeCodMermaid, RN · Mar 26, 2006

Muncie-I agree with you. However, we have to abide by the wishes of our residents and their families no matter how unrealistic they are. I had a patient die...he was a DNR...when I told his wife he had died she didn't believe me because she didn't hear any alarm. I asked her what she meant and she told me, "On TV when someone dies, an alarm goes off and the line goes flat." She just wouldn't believe that the 02 concentrator wasn't the same as the telemetry unit she had seen on ER. People have very unrealistic expectations and we as health care professionals need to educate them, but at the end of the day, it still is up to them to decide their code status.

CoffeeRTC, BSN, RN · Mar 27, 2006

Oh my...this has happened to me too! (They thought it was the IV pump or feeding pump that should have "flat lined")

No matter how hard you educate, hold hands and explain what CPR and intubation and defibing means and does to the debilitated, contracted elderly body...some families just wont change the code status.

donmomofnine · Mar 29, 2006

We have a no CPR policy. We tell folks who want the "full code" status (even after we try to educate them) that we will call the paramedics and they will initiate CPR. Those few who are full codes? Well we try to get them out of here as soon as we can ~ before they arrest! Has never gotten us in trouble the seven years I have been here.

CapeCodMermaid, RN · Mar 30, 2006

We have a no CPR policy. We tell folks who want the "full code" status (even after we try to educate them) that we will call the paramedics and they will initiate CPR. Those few who are full codes? Well we try to get them out of here as soon as we can ~ before they arrest! Has never gotten us in trouble the seven years I have been here.

So your nurses don't start CPR before the paramedics come? In Massachusetts we've been mandated to have and be trained in the use of an AED and all the licensed staff has to be CPR certified.