Codes and note taking

Thx Siri....you are just a wealth of info. I know my time will come soon to record at a code being on a tele floor--we have our share of them. this is great just to familiarize myself.

One hint: as you know, clocks can be off by several minutes from room to room. So, always chart by the time on the MONITOR, not your wall clock or yor watch. That way, your times of intervention will coincide with what's on the code strips.

holly27, a code once a week sounds excessive for any type of unit. why don't you take a peak at the code review sheet listed at the link from siri. it may help you pinpoint opportunities for improvement in pt care.

at our hospital we have dramatically decreased the # of codes by using rapid response teams to support non-icu units when they have concerns or just "a funny feeling" about a pt. the med-surg or pcu nurse calls on an icu who intervenes for earlier staff support, pt assessment and treatment and avoid deterioration to an actual code. this translates to a huge improvement in outcomes as the mortality rate for codes is about 50% at best.

check it out. and, good luck!

Late reply, but I thought I would throw in my 2 cents. We get a lot of codes in the ER. We do have a code sheet, but I'll grab a blank sheet of paper and stand by the clock when the code rolls in. Every minute I'll write something down, and just make a list minute by minute of what happens.

Ex: 1222 Pt arrival, monitor applied, asystole, CPR in progress

1223: Epi X1, CPR, checked two leads

1224 Hold CPR, asystole, 2nd IV in, 7.5 ETT taped @ 23 verified by CO2, condensation/auscultation

1225 Temp 96.8 R, CPR in progress Atropine X1

And so on. That way you get the times down and since you are charting minute by minute you aren't missing anything. Make sure and have your code leader call orders aloud, and your code nurse call aloud when order is given. They need to say it aloud so you can hear it and chart. Try and position yourself between the code cart and the clock so you can see the monitor and the time. Watch the clock, let them know when it's time for the next med. When you get comfortable with that, try and control traffic as well. Everyone comes running for a code... you'll probably need to throw some people out of the room.

After the code is over, go back and chart on the official sheet, that way you can proofread and clarify before charting.

Good luck!

Usually when I scribe for codes, I use a blank sheet of paper and then transfer to the code sheet when done.

NEED TO RECORD:

time code initiated and by who

pt rhythym(s), times of rhythym changes

times of all meds given

time pt intubated (and how ETT placement was confirmed)

time defibbed and at what voltage

time MD arrived if code initiated prior to MD arrival

time of death (and if US machine used to confirm no cardiac activity)

total amt IVF given during rescus attempt

names of every staff member participating

Our flow sheet also has a section on top for a short narrative of events just prior to code, i.e., how pt was found.

time event time event time event

time event time event time event

time event time event time event

time event time event time event

time event time event time event

time event time event time event

butofcourse. That is exactly what I was thinking. A code once a week, instead of learning what to write. Your department head should be looking into was is not being done RIGHT. What floor do you work on, I don't want to be your patient.