code signs

[mbarakhan18]

Hi everyone! I am working on a unit where patients code frequently. I was wondering if anyone with experience can give me insight as to what are early signs that my patient may be at risk of coding?

[VANurse2010]

Tell us your thoughts first and then we can provide more insight. What have you seen thus far?

[Sour Lemon]

Hi everyone! I am working on a unit where patients code frequently. I was wondering if anyone with experience can give me insight as to what are early signs that my patient may be at risk of coding?

That's such a broad topic ...is there are specific issue or event that you have in mind? Just being sick enough to be in the hospital is an early sign sometimes ...especially on a unit where "patients code frequently". I hope you work in an ICU of some sort.

[MrNurse(x2), ADN]

Do you work a cardiac unit? That is the only reason I can think of that you are seeing "surprise" codes due to arrhythmias. QTc readings can possibly reduce VT. I have to say that since the implementation of RRT's we rarely have codes, even with post op OHS patients. Frequent VS, rounding and daily labs are possibly other interventions. Only slightly tongue in cheek, administration should track staff working during the codes and look for an individual that may be facilitating these patients across the rainbow bridge.

[whatdayisit11to7Nrse]

Funny thing is I just asked a question on here a bit similar to this, and I kinda answered my question when thinking about how to answer yours :)

It helps me to write down and/or think about the things I have seen enough times; the things that I do know to some extent. And then, I dig deeper into those things. When I learn more about things I DO know, I also learn a lot of things I didn't know!

When I start to "catch on" to something, no matter how simple or complex it is, I try to understand it even more. And it trains my brain to really think and get answers.

When I was brand new nurse, I didn't know much about codes, or anything haha. But I began to see similarities in s+s of patients with certain conditions and I started to connect some dots.

For example, I noticed that many of my patients who displayed sudden and unusual behavioral changes often had something going on with oxygenation, blood glucose or infection. Other times it was neither of those conditions, because not every patient is the same, and there are a million things that could cause ANY symptom. But part of knowing what is going on is ruling out what we suspect.

I know these examples arent codes but this is how I started to grow as a nurse.

I also asked myself questions like, "Why does that condition commonly present that way?" Instead of just knowing that it does.

And two years later, that thought process has helped me pick up on more complex, less obvious things especially when there is a code or rapid response.

I hope this made sense. I am going to also post more later about my experiences with codes :)

[whatdayisit11to7Nrse]

That's such a broad topic ...is there are specific issue or event that you have in mind? Just being sick enough to be in the hospital is an early sign sometimes ...especially on a unit where "patients code frequently". I hope you work in an ICU of some sort.

Maybe he/she meant "code" in another sense? I used to think that anything requiring rapid response was a "code" but even rapid response and code aren't the same thing. I guess it can be confusing.

[HouTx, BSN, MSN, EdD]

Actually, that's a very good question/issue.... so good that there is already a National Standard of Care designed by AHRQ. It's Called "Rapid Response" Take a look at that web site. It has all of the evidence-based S&S that should trigger a Rapid Response. Most large hospitals in my part of the country have automated (or semi-automated) triggering systems in their EHRs that alert the nurse when these symptoms (of patient deterioration) are occurring.

If your organization doesn't already have an established RR system, maybe you can get the ball rolling. If it does, be sure you are aware of how it works and how to trigger it.

[BeckyESRN]

A few odd things that I noticed in my years on the floor-most of these were not "code" situation, but rather anticipated deaths- talking to or asking for their mother, talking to or seeing deceased friends or relatives, seeing children in their room, and pointed out to me by a hospice CM, uncurling of the top of the outer ear.

I worked cardio, and when they began encouraging the use of RRTs the amount of codes dropped nicely! Some warning signs that you should call an RRT, increase monitoring, or call the MD for me included: any unexplained/unanticipated change in vital signs or mental status, lethargy, confusion, change in coordination, any unexpected sudden change in output from drain/chest tube/NG tubes, I could go on for days... If ever you feel like something is off, have another nurse take a look with you, another set of eyes can be a big help.

If you are outside of the ER or ICU, ideally, you shouldn't be experiencing a high amount of code situations. Sadly, being alive puts you at risk of dying; there aren't any set in stone risk factors that are always detectable

[nutella, MSN, RN]

Hi everyone! I am working on a unit where patients code frequently. I was wondering if anyone with experience can give me insight as to what are early signs that my patient may be at risk of coding?

I need to say that frequent codes point to a whole bunch or problems. I have worked in CCU with patient who had everything known to mankind after or with cardiac disease but codes were actually not often - goal is to prevent those.

A lot of codes throughout the hospital are usually not codes because of cardiac arrest but for something else including fainting and seizures....