Coding patient without paging code overhead?

[rse3]

Today, we had a pt who was an unwitnessed arrest at home this morning, EMS/fire got him back, there was no activity on his EEG this afternoon, and he quickly bradied down and coded less than an hour ago. By the time of the second code, the patient had already been admitted to and seen by the hospitalist. When the pt went asystole, ERP went in the room, and said not to call switchboard about the code, but to get the hospitalist in there stat. ACLS protocol was initiated, and the unit secretary decided to call switchboard about the code because pt was not a DNR. Some of my coworkers were angry that the code was not called overhead immediately because of "legalities," "negligence," and "best practice." The neurologist and hospitalist were angry that it was called overhead at all. Does anyone have any insight?

[Altra, BSN, RN]

Where was the patient -- in the ED? I have never worked in a hospital where an overhead announcement or page went out for a code in the ED the way that it does for a coding patient anywhere else. But if it is policy where you are to call a code, and that wasn't done, I agree that it opens the door for ramifications, as policies weren't followed.

[Rose_Queen, BSN, MSN, RN]

Where was the patient -- in the ED? I have never worked in a hospital where an overhead announcement or page went out for a code in the ED the way that it does for a coding patient anywhere else. But if it is policy where you are to call a code, and that wasn't done, I agree that it opens the door for ramifications, as policies weren't followed.

Same here. No overhead pages for codes in ER or OR. Everywhere else, overhead page plus voice pagers for all assigned responders.

Also, what does ERP stand for? Either way, without a DNR order, policy and protocol must be followed.

[TraumaSurfer]

Unwitnessed arrest? 3rd code? EEG done in ER? Pt still in ER?

It looks like there are 3 physicians involved all on the same page that another code on this pt is futile. Was there documentation by at least 2 of the 3 physicians to back this up? Had the family been notified? Was this patient under the care of another doctor for a long term illness?

If we have at least two physicians documenting aggressive treatment is futile, we don't go all out with heroics. An ER should be able to do ACLS especially if the ERP is there and the admitting docor is called. I would assume an ETT is already in place with xrays and labs already done. A 12 lead would be nice but only if you have a rhythm, not asystole.

I think there would be a bigger issue if continued resuscitation is performed on someone whose prognosis is poor to none and if 3 physicians have documented this. Holding an ICU patient in the ER for extended time is the issue here and if the pt had been in the ICU, this would only have been a nod amongst those involved and not an overhead paged code.

[Sun0408, ASN, RN]

We don't call codes overhead at all. The ED handles their own codes, floor codes are called and a page goes out to the rapid response nurse and code team. ICU codes are handled the same, a page goes out to those that need to respond but nothing overhead..

Insight as to what happened, I really have no clue, the MD's would be the ones to ask as to why policy was not followed.

[rse3]

I'm not sure if it's policy to page codes overhead or not. It's what we usually do, but there have been a few times that I know of when the code hasn't been paged. However, this is the first time that anyone has made a big deal about it.

The ER codes are called overheard to get lab, radiology, resp, and registration there. Labs had recently been drawn, so there was no need for lab to be there. Pt was on a vent, and that was working fine. No need for X-ray. Pt already had a chart. My argument was that there was just no need for the code to be paged overhead since all of these needs had been met, AND the ERP said not to. It seems that I was the only one of my coworkers agreeing with the ERP. I know I'm making a big deal out of this, but I don't like being accused of being negligent by my coworkers, as I was actually the one beside the a phone at the time, and the one talking to the ERP about his decision.

In our hospital, codes are usually paged everywhere but surgery and NICU. Even our units usually call codes overhead, but I assume that this would have gone differently in a unit. His nurse was actually on the phone with MICU giving report when this happened, and he's now a DNR, so this won't come up with this pt again, but I guess I really need to find out the specifics of hospital policy as soon as I get to work next weekend.

[Anna Flaxis, BSN, RN]

ERP=ER Physician, correct?

If the only reason to overhead page codes in the ER is to get the resources there, and the patient didn't need those resources, then paging overhead was not necessary.

[edmia, BSN, RN]

I'm not sure if it's policy to page codes overhead or not...I guess I really need to find out the specifics of hospital policy as soon as I get to work next weekend.

Yes. You do need to know the policies and procedures, especially about basics such as what to do when a patient crashes!

Your colleagues may be annoyed that you don't know the protocol and may be feeling that you are making decisions about patient care based on your thoughts on the issue instead of protocol. That's not cool and I would be upset with you.

If the protocols don't make sense, then a conversation about that needs to start, but until then, follow them.

Sent from my iPhone using allnurses.com

[rse3]

In my defense, I did not just decide to break protocol (we're assuming it's protocol at this point) on my own accord. I was following a direct verbal order from the ERP (yes, ERP=ER physician). Order was read back and verified.

I will definitely follow up on official protocol, and also let my coworkers know what I find out, as they didn't really have a sound argument about the official protocol either as far as paging the code overhead or following the physician's order on the matter.

[Sassy5d]

I think it's a grey area. In the big picture, was any harm done to the pt by calling the code?

Take my experience, for example.

Pt needed adenosine. Grabbed the defib when I grabbed the med.

opening package for pads. PA asks what do I think I'm doing. Pa draws up and gives med without pads on. Yes hooked up to monitor.

That's great that he felt comfy enough to give the med without the defibrillator on the pt. my policy is to never give med without pads in place, in the event they don't convert. Who's booty would it have been if this turned out bad?

Tbh, I probably would have done the same thing. I want that documentation on my side that goes with policy. Especially since it has nothing to do with harm/no harm to pt