Need help with code protocol

A few questions: what's the extent of the equipment you have available (full crash cart including drugs, defibrillator?) Do you have an outpatient endo clinic and things like that to contend with, or are we strictly talking about Ethel keeling over in the waiting room before she's seen? What's your response time from EMS? :)

Just brainstorming with you :). We have a defib but some time back dispensed with the drugs. We have a similar EMS response time. We have no one ACLS certified. Your office might consider that, which would leave you with the basics of life support in which I am assuming all your staff are trained. I know it's hard contemplating not having the drugs, but really ask yourself if you would ever be in a position of actually pushing cardiac drugs, and how comfortable would your providers be in calling the shots (you know them - they may be world class former ER docs, or know emergency medicine like the back of their hand, but if they don't then having the meds available may be more of a liability.)

So for your particular office, someone needs to be in charge of:

Calling 911

Getting the crash case

Starting the whole BLS process leading up to defibrillation if necessary - pass the recording to whomever looks least up to handling anything else

Herding other patients to another area if it happens in a more public area of the clinic

The RN or LPN in her absence should be in charge of initiating this process. The doc will presumably be immediately involved and can assess the pt, determine need for CPR/defib, etc. What am I missing? - it's early lol.

And, to add to the above excellent ideas:

Be certain all in your clinic are BLS certified. Many state health agencies require this of all physician clinics. Even the ancillary personnel. Check with the laws of your health entities.

The idea of ACLS certification for all licensed personnel is a great idea. This will carry the initial BLS a step further. If you have no plans of utilizing the drugs in the ACLS protocol, I agree with Nurse Ratched, it will be more of a liability to have them and not utilize them if indicated. So, be certain your physicians plan to actually use these drugs and if not, get rid of them.

You need to have the ACLS protocols attached or inside the crash case. Never should the individual be required to recall the procedure/s and/or drugs and their dosages required, in an emergency.

If you plan to conduct an emergency using the ACLS protocols including drugs, your crash case must include (you can refer to an ACLS text for additional information):

Protocols (laminated for water/body fluid protection)

Drugs per each protocol

Oxygen

Oxygen tubing and delivery unit

Intubation supplies (ped and adult) including appropriate sized ambu bags/masks/ET tubes

Stethoscope

B/P cuff (ped and adult)

IV fluids

IV start kit

Pocket mask (these also should be placed at each HCP area for immediate use, including the front office), various syringes w/wo various sized needles, IV tubings, prep pads, razor, tape, extra defib pads, gloves ..........

Be certain you also assign someone to check the defibrillator daily. And, keep a log of said daily check. This same person should check the crash case daily as well (document on the crash case log) to ensure it is readily available and contains all the necessary items. One should not have to open this case and sift through all the items in order to verify all is there. You can obtain the "break-away keys" from the Pharmacy at the hospital. Use one to "lock" the case. When checking the case daily, one need only verify the case is "locked" and ready for use. The remainder of these "keys" should be locked in the controlled substances case/cabinet to ensure security.

Develop an intraoffice protocol that outlines how and when the appropriate personnel are kept updated. (ACLS is re-cert every two years and the office personnel must have updates/practice codes more often).

And, write a policy/procedure for all of the above. Have the physician/s approve and keep in your records. Update as needed.:)

I agree with RJ. Your physicians have no business even attempting to intubate unless they do it regularly. Any patient that needs intubation, can be successfully bagged with 100% O2 until the paramedics arrive.

And unless you do it routinely, having one or even a handful of code situations per year, is not going to keep you comfortable with it. What happens is you do not have a physician in the office at that time?

Best suggestion, make sure that you have functional O2 and an AED. By the time that you get thru with getting an IV started, you are going to have a team there. That patient can have compressions done and bagged, and you will still have the same outcome. The key is to get them defibrillated as soon as possible.

I definitely would not start with the full cart. Your office is not equipped for it. Safer for everyone if the paramedics are there in just a few minutes.

And what happens if you have polciy in place, and no doctor on site then?

And to add to that, most family practice physicians do not intubate routinely, even if they just finished a residency; or even run a code.

At least not in any of the training programs that I have ssen thru the years.

A couple months of ER medicine or a month in the ICU...............you lose skills and quite rapidly.

What are their skills like for placing central lines? Or even an IV? In most hospitals, the nurses place the peripheral IVs.

Bagging with 100% O2, compressions, and the AED are all that you need.

Same thing that the airports have until the medics arrive.

I Need Help Iam Going To Give Lecture About Code Blue Procedure And Policy Please I Want This Subject In Detalis

Thanks

Hello, ashour,

I sent you a private message about where to find this.

Here it is again. Please check in any Basic Life Support text (from the American Heart Association) for the protocols for "code blue"/cardiac and/or respiratory arrest. Also, check in the ACLS (Advanced Cardiac Life Support from the American Heart Association) text as well. Very detailed and utilized everywhere.