Published Feb 20, 2000
Who responds to a "code" in your institution?(code 3/code blue etc)
We are currently reviewing our process for "codes" in our institution in order to decrease response time as well as maintain high standards for patient outcomes. Can you please share your "code" process with me?
We utilize a Code Team. CCU is the code leader and a secondary person comes from one of our other ICU's. The secondary is assigned on a rotating basis. The ER calls the area announcing a Code and asks if a Physician is needed. The ER Doc responds if necessary and stays until the attending arrives.
For Pediatric Codes the MICU is the code leader as well as the secondary . We use ACLS/PALS protocols.
In the hospital I work at, we also use a Code Team. The charge nurse from ICU is IV/med position. The charge nurse from CCU is defib/monitor position. The charge nurse from PCU is the recorder. The RT supervisor is airway position. The PCA's do compressions. The ER doctor comes & runs code when he arrives. The nursing supervisor/unit manager comes and directs flow, positions, speaks with family, makes sure all calls are made (like needing unit bed if successful and making other calls if it is not). We also utilize ACLS & PALS protocol.
I also feel it works much better to have the multiple areas help with a code in a unit setting, not just having the unit run the code with no help from outside resources.
At my last staff job, the house RT responded, the assigned anesthesiologist, and the patient's nurse was there for information. A staff nurse from either ICU or CCU went (assigned at the start of the shift and with the units alternating months to share the wealth) and about 4,000 residents from the services that had patients on that floor. And to bring up the end of the parade were the nursing supervisor and the IV team. Quite the crowd!
I work on a cardiac stepdown unit where most of our nurses are ACLS qualified. Our hospital calls either a code 99 (meaning an MD is already present) or a code 100 (no MD present - usually the ED doc shows up). In either case, our staff nurses initiate compressions, ambu-bag resps, getting the crash cart in function, starting an IV line (we usually have IV's in all patients already per floor protocol) and getting meds ready. Usually by the time we get all these things done, a code team arrives from the ICUs or ED, along with the resp. tech. The RT does intubations and the doc takes over from where our ACLS nurse has left off. The primary nurse is freed up to brief the doc and call the family. The charge nurse gets all unnecessary personnel out of the area and deals with the family if they are present at the time. One of our staff nurses documents the code, and either one of our staff nurses or a nurse from the code team pushes the meds. Our codes usually go smoothly, as we staff nurses are used to having codes on our floor. The charge nurse really helps by getting rid of the extra staff who show up - it can really look like a big circus if the extras aren't sent away. There have been times when we have run our own codes when the code team is tied up elsewhere - that's why it's important for management to get their nurses ACLS certified. I know our ICUs run their own codes internally - no announcements are made overhead. Hope this helps.
We have a code blue team at my current facillity. I feel this is a valuable resource but, I also feel every unit/floor should have people who are ACLS certified in order to efficiently initiate advanced life support before the team arrives.
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