Is there a Doctor in the house? Working a code without one in an LTAC

[MrsWampthang]

I work in a freestanding LTAC and there are times when we have no doctor present. In the case of a patient coding, we are supposed to call the doctor on call for that patient's group, and take orders from him/her over the phone for working the code. Until the doctor calls we just follow ACLS protocols. We're not supposed to call EMS to come and take the patient out either. Does anyone else work places that do this? I have to admit, I'm not really comfortable with this. I guess I'm not very trusting because what if we get a doctor on the phone who won't give orders or, in the case of a bad outcome, refuses to call the code over the phone, or doesn't admit to giving orders, or never even calls back, etc. What do you all do in your LTACs? Thanks for any and all input. Sorry if I sound paranoid.

Pam

[ZippyGBR, BSN, RN]

I'm not a nurse, but calling EMS doesn't make sense either.

Mainly because, I recently found out that not all EMS are difibulator certified and in cases of a code, have to WAIT on the person that is certified to show up before they respond, and of course, you mine as well not even leave the house b/c the person will be dead.

No way would I work in a facility where patients were coding with no doctor.

...defibrillator skills are including in the vastest majority if not all emergency ambulance crew training standards across the developed world as well as many 'advanced first aid' or 'first responder' courses...

in terms of the OPs position given the fact they refer to following ACLS protocols suggest that they have staff with ALS skills and appropriate equipment available... however that's not a reason not to call for EMS - as if the patient is successfully resuscitated they will require admission to CCU/Level2 or lev3l 3 critical care beds depending on whether they got ROSR / are still vented and also on their haemodynamic stability ... there is also the possibility of intervnetional procedures depending on the client group the OP's LTC facility deals with ( e.g. younger physical disabled client groups ... or enduring mental health client groups)

[Daytonite, BSN, RN]

Doesn't the facility get charged by the city for the use of the EMS services when 911 is called? That might be where the idea of not calling EMS services comes from. Somebody left out the rest of it, that you need to call if it is necessary. As said in your second post, I would bring this up in your next PCC meeting. It's a valid concern and needs to be addressed before it happens, not the day after.

[KellNY, RN]

Doesn't the facility get charged by the city for the use of the EMS services when 911 is called? That might be where the idea of not calling EMS services comes from.

I could be wrong, but I think the Pt's insurence would cover that (or the pt's family for the copays and whatnot). That's how it's been where I've worked. We had one great son who cursed us out for calling EMS on his mother when she had a FS of 34 and was in a stupor...and a daughter in law who chewed us out over her $50 copay for when we had her mom transported to the ER when she tried to jump out the window and when staff tried to calm her, she tried to stab us with her scissors.

[traumaRUs, MSN, APRN]

I guess my biggest concern is what type of care are you suposed to provide these patients? Do they realize they might code and not be transported to the hospital? Do you have the ability to figure out WHY they coded? What type of ICU do you have? Is it free-standing too? Are you able to do ABGs, CXR, CT? My concern is that you might be practicing out of your scope of practice. Good luck.

[platon20]

Wait a sec, regular RNs have the authority to push epinephrine, dobutamine and the other pressors during a code without a doctor's order? I must have missed that. Usually you need at least a nurse practitioner to order those drugs.

I didnt know that RNs were certified in ACLS and can run codes on their own with no doc present, including using the defib machine as well as pushing IV pressors.

[ZippyGBR, BSN, RN]

Wait a sec, regular RNs have the authority to push epinephrine, dobutamine and the other pressors during a code without a doctor's order? I must have missed that. Usually you need at least a nurse practitioner to order those drugs.

I didnt know that RNs were certified in ACLS and can run codes on their own with no doc present, including using the defib machine as well as pushing IV pressors.

standing orders?

Patient group directive?

exemption from medicines legislation for adminstration in life threatening situations (still has to be obtaiend thorugh the proper chain of ordering and against medical direction...)?

all situatiosn whichg apply here o nthe right hand side of the pond for ALS type drugs

defibrillation is a skill taught to first aiders ....

[TazziRN, RN]

No, ACLS. If you're ACLS certified then in the absence of a physician a nurse can order and push the meds as long as they are within the ACLS protocols.