How do you handle codes?

[xoemmylouox, ASN, RN]

In my clinic I am on the "code team". It isn't organized well, and half the time only half of those who are on the team show up. It is frustrating and puts patients at risk. What do you do if someone codes at your clinic? Do you have a team? Who is on it? I think ours needs a SERIOUS reform and I would like some ideas on how other places run theirs.

We break ours down into 2 types:

1 - Where someone is down, but is still responsive such as a fall.

2 - Code Blue = non responsive

Thanks.

[brownbook]

In my clinic I am on the "code team". It isn't organized well, and half the time only half of those who are on the team show up. It is frustrating and puts patients at risk. What do you do if someone codes at your clinic? Do you have a team? Who is on it? I think ours needs a SERIOUS reform and I would like some ideas on how other places run theirs.

We break ours down into 2 types:

1 - Where someone is down, but is still responsive such as a fall.

2 - Code Blue = non responsive

Thanks.

YIKES! How big is your clinic, what kind of clinic? How many doctors, anesthesiologists, and RN's are working there?

Staff assigned to the code team must show up and if they do not (without a VERY GOOD reason) they should be given a strict lecture by the boss even an incident report could or should be made.

Why isn't staff showing up? Do they have pagers, is the code blue announcement loud and clear?

We don't even have a code team, so many staff get that (I hate to say it sounds cavalier) but get that adrenalin rush and excitement and want to respond, usually too many show up. We have never had a full cardiac arrest code. Once in a while the code button gets accidentally pushed and even then every one runs to help.

Even just a nurse calling for "I need help here, or get me anesthesia," gets a lot of immediate help from co-workers.

I just can't understand medical health care workers not responding to a code? What type of people are you working with? It is mostly LVN's and CNA's who don't think they have any role in a code? Your story is so opposite of any situation I have ever been in it boggles my mind.

Are you in a Long Term Care facility where so many of the codes are unfortunately just the natural death of a patient who should be left to die peacefully, then I don't wonder that staff might be a little hesitant to be bagging and compressing. Why does your clinic have so many codes?

[xoemmylouox, ASN, RN]

Well I work in an outpatient physician office. We have MANY specialties and or services here so that is why we have so many codes. I think a lot of people don't want to get involved. We have a list of people who are supposed to respond, but it is not organized well. I want to help fix the problems we are having which is why I am looking for examples of how things go right.

[brownbook]

I have never worked in a clinic setting like yours. It sounds like a real liability as in someone is going to get sued. I say that so maybe your office manager or which ever doctors are running the clinic will take this issue seriously.

It should not be rocket science to make a roster of who is on the code team. Maybe a sit down meeting with everyone who can be on the code team, with sodas and pizza, will get them to come. Ask them for their input, maybe they think the code response is just fine? Listen to their concerns, complaints, (whining, ha ha) and get concrete ideas of how to make it work better.

Hopefully if they feel their concerns and input are taken into consideration they will buy into what ever the code blue response plan is.

Again it isn't rocket science. A code blue is called and they respond. They do all have ACLS I assume?

You could probably pay for an ACLS instructor to give a in-service (not an ACLS course, just some advice), to the group, cheaper than the lawsuit.

[mappers]

We call 911. We all have BLS and we have an AED. Once we actually started a line and started NS, but the paramedics took over . No Code teams.

[xoemmylouox, ASN, RN]

We do have ACLS cert. people, but we just need to get organized with things. I would think maybe running mock codes would be an excellent way to establish roles and to hold those accountable who should be there.

[brownbook]

I hate codes. They are, shall we say, very stressful. It sounds like you have more than the average. I hate them because we have so few I get the code jitters, "what do you give for slow V-tach, how much amiodarone do you give," etc. Maybe that is why your co-workers hate to come?

I read on another AllNurses thread about OOPA. It apparently has been mentioned in ACLS classes (I had never heard of it.) It focuses on why people freeze up under the anxiety and pressure of codes. It stands for Orient (to the situation): Observe (what needs to be done,): Plan, and Act. Actually that isn't exactly right, I keep forgetting exactly what the P stands for, but it is the idea of no matter how much, often, or well someone does ACLS they freeze, panic, in a real code.

I don't even like mock codes!!!! I still feel awful performance pressure! But saying all of that we all need to step up and do our jobs.

Maybe discussing performance anxiety and the natural stress response before having mock codes may be helpful?

[cardinalle]

I work in a clinic with many different specialties, but the majority of our codes are vasovagal reactions in the tiny outpatient lab, or falls in the parking lot. Our clinic has an official policy that "any available" RNs are to respond to all codes, however the first aid bag, AED and crash cart are in our department, so available or not, we always send 2 ACLS RNs to any code. In the case of cardiopulmary arrest, one of our docs comes along. Fortunately there are usually other RNs and MDs responding, the bigger problem is to determine who is leading the code!