MD Present to Defibrillate?

[Music in My Heart]

Reading through TheCommuter's article regarding the "deskilling" of nursing got me to thinking: Does your facility permit ACLS nurses to manually defibrillate without an MD present?

It's pretty simple stuff and there's a good reason to permit it: Namely, time-to-CPR and time-to-defibrillation are the two best predictors of outcome for cardiac arrest.

The question is, does your facility empower its nurses to act in the best interest of the patient or must you wait for the MD/code team before defibrillating?

[PunkBenRN]

Is this a joke?

You would waste so much time waiting for someone to give you the okay. AED's are designed to tell you what to do and when appropriate, all you need is a BLS, and even that I don't think is necessary.

Just do it.

[Fiona59]

AEDs are wall mounted and available in public areas, so yes we can use them. The public can use them.

The last code we called, the crash team arrived in under two minutes (two floors down from the ICU, they said it was the elevator that held them up!). You can hear the crash team before you see them. Some of the best sprinters I've ever seen.

[ckh23, BSN, RN]

On the floors in my hospital the monitors have a built in AED so they can slap the pads on and shock if advised to while awaiting the code team.

[tamadrummer]

No we don't wait for the md. That should be considered poor quality care if the people on the code team cannot save the patient because the md isn't there. I'm a brand new nurse and as an acls RN on the code team I expect to be doing compressions and giving resperations until the full team assembles and as I learn I will progress to Meds and documentation but the lead icu nurse many times in our hospital runs the entire code as the ER doc never shows up. The pt has no chance without electricity if we have to wait for the doc.

[xoemmylouox, ASN, RN]

I think this is a good question. I'm sure there are plenty out there who didn't know the right answer. I am also on the code team, and sadly trying to get a doc to show up can take forever. We don't wait, we just get going.

[BluegrassRN]

That's the entire point of ACLS, to get things going until the team arrives. In my hospital, you don't even have to be ACLS certified to shock, as the defibrillator has the AED setting and will advise those who are unable to read rhythms.

Our team is so fast, though, I've never been in a situation where I've shocked before they arrived. We have a cart on our unit, by the time another nurse grabs the cart and gets it in there, the tea arriving. They are awesome.

[Music in My Heart]

I'm encouraged by the results of this poll. I'm glad so many organizations permit their nurses to run the ACLS algorithms by protocol. We can administer manual shocks (no AED) but can't push meds until the MD shows up (which they typically do very quickly).

[npatte1071]

Does your facility allow it and does your state allow it?

Natali L. Patterson, MSN, RN

[Music in My Heart]

My facility permits manual defibrillation but no meds. The state permits meds if covered by facility protocol/standing orders.

[PunkBenRN]

I'm encouraged by the results of this poll. I'm glad so many organizations permit their nurses to run the ACLS algorithms by protocol. We can administer manual shocks (no AED) but can't push meds until the MD shows up (which they typically do very quickly).

By the time you call the code, start compressions, attach the defibrillator, and start an IV, the MD probably be in the room

[sonja77]

Our team is so fast, though, I've never been in a situation where I've shocked before they arrived. We have a cart on our unit, by the time another nurse grabs the cart and gets it in there, the tea arriving. They are awesome.

I've had the same experience. The question whether shock before an MD arrives (usually the ER MD) has never presented itself; by the time the crash cart gets to the room and everything is hooked up, the code team has already arrived.