Codes

[applesxoranges]

Ok, maybe I am just burned out but I am seriously annoyed at how codes are run at this one facility that I work at. It feels disorganized and almost unsafe.

1. Everyone has to run into the room. OMG! Seriously. Every RN in the ER (about 7) decided they had to be in the room. We still have about 18 patients in the main floor so I stayed out. This is plus doctor and 2 respiratory therapists.

2. The two techs were walking around the main ER and I made a comment about why was every RN in the code room. They said "they need them all in there" and started listing off jobs." I pointed out that usually in most facilities techs do compressions. Their defense was "he did a round." Seriously? Also, other facilities I've worked in we have rotated people into the code to give people a break. Think about it, even if it was just one tech in there and the other stayed on the main floor then that would have been 1 more nurse that would have been on the floor.

3. In a facility where there is a cath lab and we ice them frequently, we may have that many people in the room to help set up with the ice stuff. The cardiac ICU nurses usually run the drips and the machines. However, that is usually 4 nurses, a doctor, and the charge nurse or house sup acting as a runner.

4. We don't get codes in the ER frequently. I think of four since I've worked here which leads to a "omg! I want to do compressions."

My issue is that it doesn't feel like the codes are efficient or properly utilizing resources. The main ER does not stop because there is a code.

We've run codes with less people at other facilities. The chest compressors do not have to be RNs although the RNs should rotate in to help prevent fatigue. Maybe it is also a combination of EMS where we have knocked down the roles a lot less than what it used to be.

What are your thoughts? How are codes run in your department?

[emtb2rn, BSN, RN, EMT-B]

Sounds like how codes on day shift at my facility are run. They actually page them over head and that brings down every nosey Nancy "to help". When you've got scrub techs and your CEO in the corner of the room - somethings wrong. And that's just one more reason I work nights

We run a lot of codes but very very rarely call them overhead. Most of our codes arrive in progress anyway.

[Lunah, MSN, RN]

We run a lot of codes but very very rarely call them overhead. Most of our codes arrive in progress anyway.

I know, right? I understand overhead paging codes that are on the floor, but those that are in the ER? Really? Why??? That's what the ER does, there is no need to bring the rest of the hospital running unless you are a teeny, tiny facility and/or really need help. But paging them overhead on a regular basis? Nuh-uh.

[Bobjohnny]

I know, right? I understand overhead paging codes that are on the floor, but those that are in the ER? Really? Why??? That's what the ER does, there is no need to bring the rest of the hospital running unless you are a teeny, tiny facility and/or really need help. But paging them overhead on a regular basis? Nuh-uh.

There was a facility that I used to work contingent at, that when the code button was pushed it would send a notification to the iPhones assigned to House Supervisor, ED Charge, ICU charge & Hospitalist. It also would send a notification to the pagers for the assigned team members from the various different departments, it was fantastic.

That place had the best cooperation between inpatient and ED staff. ED went to inpatient codes & ICU came to ED codes/traumas/etc.

[pugmom79]

I know, right? I understand overhead paging codes that are on the floor, but those that are in the ER? Really? Why??? That's what the ER does, there is no need to bring the rest of the hospital running unless you are a teeny, tiny facility and/or really need help. But paging them overhead on a regular basis? Nuh-uh.

Work in a busy level 1 and we never page them either

[MedicFireRN]

I remember attending a lecture at a convention — I think it was an ENA thing — in which an RN talked about designated roles in codes, and their facility actually gave lanyards to the code team. Each role was embroidered on each lanyard, and you weren't getting in the room without a lanyard. Each role was fully trained — for example, if you were the monitor person, you were an expert with that monitor. Helped cut down on the duplication of efforts and overcrowding. This was for a hospital-wide code team, but the concepts could apply to codes in the ED as well.

The ER where I used to work did this. They also did it for all Trauma alerts. It worked really well.

[Lunah, MSN, RN]

The ER where I used to work did this. They also did it for all Trauma alerts. It worked really well.

I was thinking about trauma lanyards in my new facility. Currently there are stickers/nametags, but ehhhhhh .... they're not loved.

[sensibleshoes]

Hi, tech here. Codes are also a circus where I work, and the room is usually crammed full of people just like, watching? I see the importance of being available to run for supplies or provide relief for compressions but typically there are so many nurses in the room already that I keep my distance. I stay close to the room, however, in case they need help with the previously mentioned tasks.

So, my thought process is: if there are 7-8 nurses in the room already (too many, I agree) there's really not anything I can do that an RN can't do in that situation. I would not also squeeze in to insist upon doing compressions if it means displacing someone who can give meds in addition to compressions, etc. If you make reorganizing the code process a project, it should be emphasized that techs at least stay nearby to help as needed but also are in a position to answer call lights or alert nurses to alarms and stuff they might hear from outside the room. However, in certain situations I've been in my "place" (or lack thereof) in the code becomes clear and yeah, I do my best to avoid being yet another body standing in the room gaping at the situation.

[floridaRN38]

When we have codes in our ED. (Which is everyday) IF I see the room packed with many RNs in it. I usually just stick my head in and say "do u need me to get something". Most of the time they r fine. Other times it is as simple as grabbing more stuff to start another IV, or tubing, or meds not in the crash cart.. Sometimes it is full of staff and sometimes I have been in a code where I'm yelling for help. Just never know