how CPR training and practice is going on on your unit?

[Barak]

Hey all, this is my very first post!

I work in ISRAEL as a RN in general ICU (medical/surgical/trauma/burns/neuro etc.) and also former paramedic

These days I was given the task of improving the CPR quality in our unit. usually CPR in our unit is a total chaos! no dominant team leader...3 RN preparing drugs, one big guy is pumping, 3-4 doctor screaming general orders...nobody documents...we usually go off protocol (3 mg epi in one shot) just because "I saw it works".

as a paramedic it's very frustrating, in israel paramedics can only work in ALS ambulances and i have no permisions at all in the ICU...and be damn' sure that as paramedics we work "by-the-book" and almost every CPR looks like a demo video :)

in the hospital, and i think that this is the MOH requirments:

all RNs must pass BLS exam written ad practical every 2 years.

all CCRNs and MDs are required for ACLS every 2 years.

besides that, i have never seen code training combining RN/MDs together.

i want to start common drills on a weekly basis, and i've benn watching many codes of american in-hospitals departments on youtube in order to learn how it goes...

so...how CPR goes in your ICU?

how often you practice?

you practice RN only or with MDs?

do you have your smart manikin in the unit or u get practice day?

do you detailed protocol saying what is every nurse's role?

please be detailed.

TX.

[Okami_CCRN, BSN, RN]

This is what happens in my ICU

Resident Physician will run code (others will show up but only one will be giving orders)

Respiratory therapy will establish/manage the airway

One RN will prepare medications from the code cart

One RN will administer these meds

One RN will document

One RN will act as a float

CCT or techs will act as supply getters/chest compressions

Surgical resident may arrive to insert triple lumen catheter

As far as training all ICU RN's must be BLS/ACLS certified, they must take a yearly defibrillator class, and participate in a yearly MEGA CODE where they are run through a mock code situation with residents. CPR dolls are not kept on the unit, they are in the nursing education office. There is no set protocol dictating what everyone's job is, we just know where we are needed and have worked as team for so long that we just instinctively do what we have to.

[lilredrn]

Running the code: There is a pecking order. If the intensivist is in the unit and available, they run the code (Place ETT, CVC, etc). It is their turf after all If unavailable, the ED doc will run the code and consult the hospitalist. ED MDs are proficient in placing ETTs and CVCs as well. The hospitalist may run the code if they feel comfortable as well (not as common in my hospital - they have their hands full!). If ED MDs and intensivists are not available, we may need to contact anesthesia for ETTs and CVCs for the latter.

All hands on deck: Every available staff RN in the ICU shows up (save one for watching monitors / call lights).

Recorder: One RN charts (Generally this is the house supervisor).

Meds: ICU dedicated pharmacist shows up with their tackle box of code meds (awesome because they'll mix drips on the spot!!!) Or one RN gets meds out of the code cart. Another RN pushes meds. Another RN manages drips.

CPR: everyone else circulates doing compressions. RT bags the patient.

Hs & Ts: If possible, the patient's assigned staff RN stays out of an assigned position to discuss what might have precipitated this event and to comfort the family.

Auxillary staff: If we're lucky we will have on auxillary staff member to help out as a rover. If not, whomever is managing drips and scanning meds can run for supplies as needed.

We are all ACLS certified in my unit and have "mock codes" annually during a scheduled shift. They are are called overhead just like real code blues are and all appropriate available staff respond. Our ICU charge generally ends up running the code. Pretty empowering. We get feedback on things like the quality of our compressions, time from code to start of compressions, etc. Our nurse educators go out to all of the hospitals in our hospital system to do these mock codes. It is a good learning experience. We honestly don't debrief as often as we should post-code.