Codes - Your Procedure

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Just curious...

I was just wondering if you guys are allowed to administer epinephrine and begin CPR (even though epinephrine would fall under ACLS) without a doctors orders? I know that when I first began working at the hospital I work at now, ER nurses weren't allowed to do anything other than page the doctor and start BLS. Now of course, the procedures are all different since I'm in the ICU/CCU.

I understand that some hospitals have strict guidelines, but if you wouldn't mind just sharing with us what nurses at your hospital or facility do when there is a code, I'd appreciate it!

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Specializes in ER/Geriatrics.

The doctors order the drugs.....it is not in nurses scope to order drugs.

Liz

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The doctors order the drugs.....it is not in nurses scope to order drugs.

Liz

Thats what I've heard so far from other people I know in hospitals as far as coding goes. I guess it's different in the ICU as far as codes, since most of the patients can't always wait for the doctor to get there. The nurses I work with will go ahead and push medications and what not, and end up telling the doctor after the case.

Thanks for sharing!

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Specializes in ER/Geriatrics.
Thats what I've heard so far from other people I know in hospitals as far as coding goes. I guess it's different in the ICU as far as codes, since most of the patients can't always wait for the doctor to get there. The nurses I work with will go ahead and push medications and what not, and end up telling the doctor after the case.

Thanks for sharing!

I would love to know what you mean.....if there is a standing order for something I can understand.......do you mean they push epi, procanamide etc without a doctor?

Liz

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Oh no! We don't just randomly push meds to any patient. In our hospital (I thought it was always like this in all hospitals) we have 'Code Forms' for each patient, which is instructions on what to do if that patient codes, prior to the doctor arriving. In most cases, this just consists of us preparing the crash card, pushing a LS med and starting BLS (CPR).

These forms are put together by either the hospital doctor or that patients physician upon their arrival at the hospital - based on their condition, known allergic reactions to medicine, etc.

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Specializes in cardiac/critical care/ informatics.

we have standing orders for all telemetry patients that contain acls meds so we don't have to wait for a doc.

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Specializes in ICU, Research, Corrections.

We follow ACLS procedures until a doctor arrives. In my last code, a doctor didn't even show up :trout: Well, one happened to waltz by about 15 minutes after the code was over.

The doctor covering ER is supposed to come in 5 minutes or less. I don't know what happened with that. If we would have waited 5 minutes, the patient would have been a dead patient.

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Our ICU nurses run all codes in the hospital and are able to initiate ACLS without physician involvement.

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Our ICU's have an ACLS requirement of ALL the nurses. Our policy states that we may administer and treat under the algorithms of ACLS until either the ER doc shows (15 minutes or more), another MD is gracious enough to show or the primary gets there.

we do NOT need a doctor there to order the drugs, policy allows the ACLS protocol. Now don't dare deviate from it. It was very difficult awhile back to actually get a doc to show in the ICU until the primary got there (who didn't really know ACLS )and we just did our thing until we were successful or they callled it. Now we have hospital paid MD's who admit to all pt's without a doc who respond quickly.

The ICU's rotate the rapid response beeper and in all floor codes the ICU rapid responder and a resperatory therapist show up and do ACLS (the floors initiate BLS and record).

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Specializes in ER/Geriatrics.

On the floors by the time you start a line, open the airway, bag and start CPR the code team is there with the electricity and drugs and a doctor....In the ER there is always a doctor in the department so by the time we roll the cart in the room the doc is there. I think most ICU's haved a resident or intensivist pretty close by....so by the time things get going a doc is there to run the code.

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Our hospital is the same; we follow ACLS with or without a doc's presence. Our ER docs bust their butt to get up to the code immediately; but if they are running a code in the ER along with a couple other very critical pts, they can't always run up immediately and run the code on the floor. Any doc on the floor will respond until the ER doc gets there (that's not always helpful, frankly, but I appreciate the sentiment); but in the middle of the night there just aren't the docs around. I'm not going to sit there with my thumb up my butt, waiting for a medical doc to get there to order the meds.

Our facility has standing orders for meds and procedures in the event of a code blue, and we also have standing orders for certain meds and procedures with our rapid response team--labs, xrays, ekgs, head or chest CTs--it's great. No more having to watch someone deteriorate to a code while you are desperately trying to get a doc on the phone because you know the dude is having an MI or throwing a PE or stroking out. We can initiate a lot of the care (IN THE PRESENCE OF A RAPID RESPONSE TEAM--no, we can't just do it on a whim) when some decides to go south in a hurry. Our code teams and the rapid response team differs really only by the presence of a doc--the ER doc isn't required to come up for the rapid response call, but they often do.

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Specializes in critical care.

we also are allowed to start acls protocol. We also have an emergency management standing order set that includes fluid boluses, dopamine, o2, ekg, etc. and we would be punished for not starting these things. (i work in cc) CAT

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