Improved Trauma/Code Response

[canoehead, BSN, RN]

I’m looking for ways to improve our organization and efficiency in a trauma room situation. We get mix up in roles, people running for supplies, general chaos, and such a crowded room that people can’t get to the patient. How do you avoid chaos in your hospital? We call codes overhead, but every student available comes to watch. Who decides entry to the room? How do you assign duties as the doc calls out orders? 

I see the best way to evaluate our code process is to video tape the codes. Has anyone worked for a hospital that does that? If so, can you PM me your managers name and email ? I need to ask about legalities and procedures, a resource person would help.

[Wuzzie]

Can you give us an idea of who makes up your trauma team?

[Rose_Queen, BSN, MSN, RN]

Our roles are assigned at beginning of shift for who is primary trauma nurse, who is secondary nurse, who is the CNA responding, etc. we don’t wait until a trauma is called. We also have a red line on the floor- if you aren’t on the response team, you don’t cross that line without being invited. We do record and the video is reviewed by the trauma administration team. 

[JKL33]

It also seems like you need to consider other ways to activate a trauma code without paging overhead.

[trytounderstand]

If they do not have a role, they have no business being in the way.  Trauma cases are life and death situations.  The patient comes first not a student or any other onlookers...

[JBMmom, MSN, NP]

I think that in many smaller community hospitals this is an issue. We don't have a dedicated response team, so the overhead page brings a code response nurse from the ICU, respiratory therapy, IV therapy, the physician, the pharmacist, anesthesia and the nursing supervisor. (If the code is at the night/day change of shift it's a nightmare because EVERYONE shows up). 

As the responding ICU nurse I'm usually responsible for giving the meds in the code. However, whether it's my personality or my actual responsibility I usually end up running the room organization between medication administrations. I think it's all about keeping the noise level down, minimizing traffic and knowing roles. If someone involved is a spaz that just creates chaos. We have one nursing supervisor that turns every code into a circus, sometimes there's not much you can do about it. Most of our codes run pretty smoothly, which sometimes surprises me because we can go a couple months between codes and not many staff have much experience with them. 

The ones that go poorly, though, are a nightmare. I understand that students are there to learn, but rarely is there room in the room for a body that isn't actively involved. If it's in our progressive care unit the room would be big enough for someone to stand in the corner and not be in the way, but not in our standard rooms. 

They used to do mock codes with our sim mannequins, but not in the almost 4 years I've been there. Wish I had some great advice, I look forward to reading what works for other places. 

[Wuzzie]

The reason I asked about the makeup of the team is because in all the trauma centers I’ve worked it’s usually very specific roles with very defined responsibilities. And by defined I mean defined. Even where you stood was pre-determined and was the same for every trauma that came through the door. You didn’t step out of your lane for anything unless something bizarre happened. For example the recorder (always a member of the CCT team if they were in house) would record and also keep the noise under control so the record was accurate. We sometimes had to be extremely aggressive to make that happen if things were getting loud. TN1/Medic was patient left IV access and monitor placement. TN2 was patient right IV access, foley placement and medication administration.  Anesthesia placed the airway and stepped aside after it was secured for the TRT who placed an OG and then took over bagging. The TEDT pulled supplies. A second EDT stood on the periphery and retrieved supplies that were not in the trauma room. ED resident assessed. Surgical resident placed central lines and CTs if needed. The nursing supervisor controlled entry to the trauma bay and sent away the lookie-loos. The remainder of the team stayed on the periphery until their services were needed at which time they would step into the circle, complete their task and then step out. It was rigid, efficient and got the job done. We aimed for no more than 15 minutes from door to scanner and we very nearly always attained that except for trauma codes and severe burns. 
People who were designated “trauma team” for their shift carried a special pager that was only for traumas and codes so it didn’t matter what unit you worked on. They were never paged overhead. 

[LibraNurse27, BSN, RN]

Wow, not paging overhead sounds brilliant! I worked at a small community hospital, and as others mentioned they overhead paged codes and not only the code team but a million others would run. People would run by and look at me in disbelief that I wasn't running to "help with the code." I'm not on the code team, I'm not great at staying calm, and someone needs to take care of all the other patients in the hospital! I hope you can get your hospital to do what other posters mentioned with the special pagers for the code/trauma team, and having assigned roles all shift, not just when the code starts trying to decide who does what. 

[canoehead, BSN, RN]

This is very helpful, we are looking at not calling a code in the ER, we usually have enough staff, and we know where everything is. I expect that will make life easier.

[summertx]

On 3/21/2021 at 11:12 PM, canoehead said:

 

I see the best way to evaluate our code process is to video tape the codes. 

Isn't this a HIPAA violation? Is this videotape available to the family and are they aware that there is a video? 

[CharleeFoxtrot, BSN, RN]

20 minutes ago, summertx said:

Isn't this a HIPAA violation? Is this videotape available to the family and are they aware that there is a video? 

My thoughts exactly.