need help with code checklist/med sheet for codes

[missapoo]

Hey everyone! Hope there is someone out there who will be able to steer me in the right direction for finding info on code checklists and med sheets for codes. We have had 2 codes that ended up badly within the last month or so and our director has put me in charge of trying to come up with something useful as far as organizing the way we handle a code and also documenting what goes on in a code ie a code record sheet and possibly a med sheet that is wt specific for each pt that is put at the bedside upon admission to the unit in anticipation of a possible code situation.

We don't even have a unit-specific policy for codes so I am starting from the ground up. I am working with pharmacy on this as well...they are looking for a computer program that we could use to enter our pt info in and get a printout on common code meds. Currently we don't have meds locked up on a crash cart in our unit (we have a computerized omnicell in the unit that requires login and password to access drugs which takes precious time). The old timers argue that if we get the locked crashcart with meds we will have to start counting drugs monthly or more often and this will require more work/effort to keep up etc...I think it is time to have it all there, ready to go as much as possible and within easy reach so we aren't scrambling in the event of a code situation. I just see this working out better especially in light of the fact that we just had the 2 codes that passed and I am reviewing everything I can get my hands on and trying to make a rational decision that will effectively get us better results in the future. I am just wanting some input from other NICU nurses as to what you do on your units as well.....thanks a bunch!!

Melissa

[dawngloves, BSN, RN]

We have code meds boxes that pharmacy checks every month. But when I did adults we checked the code cart once a month and if two people did it, it took all of 15 minutes, so time consuming is a poor arguement when you consider the time it takes to run back and forth to the Pixus during a code.

We also have a code book and you can flip to the page of your pts weight and the med dosages are there. There is also code sheets in there so the recorder can chart vitals, meds given, lines placed, intubation, and such.

[nell]

Hi Melissa,

If you PM me, I can email you our code policies.

Our crash carts have modules that are filled and sealed by pharmacy or central supply with expiration dates that are monitored by us on a regular basis (I forget what is daily and what is weekly). Thus, there is no counting of drugs. I sort of think that going through the crash cart to count/restock on a regular basis is good for knowing what's there and where things are, so I also have a Flash video of our crash cart if you are interested (it's 755kb).

I have inventory sheets of what is on the crash cart, forms of who's on the code team and what their responsibilities are.

As far as code med sheets for weight ranges, I know there are some programs online that let you input the weight and print out a sheet for an individual patient. We have laminated sets of code med cards (one card for each weight range) that hang on the monitor at each bedside (weights change and the individualized ones need to be updated on a regular basis as the baby grows)- if you don't find something suitable before next Wednesday, I can find out where ours came from, or maybe get a copy. Also, I can get a code record sheet at that time if you still need it then.

Best of luck in this endeavor and I hope you are moved up the clinical ladder bigtime for your efforts.

nell

[TiffyRN, BSN, PhD]

One item I can address is the code med sheet we tape to each infant's bedside. Every baby on admission and then every Sunday has a code med sheet updated for their current weight. I'm not sure I can remember all the meds that are on there but I'll try; we right down the correct dosage and ml's for the infant's current weight. It is checked by 2 RN's.

The meds are:

Epinephrine

Atropine

Calcium

Sodium Bicarb

Plasminate

I think those are the ones but they are on preprinted sheets with the correct dosage as far as like: 0.01mg/kg then a blank for the correct dosage to be written in. It's one less thing to stress over when you are in a code situation.

[missapoo]

Thanks to all of you that replied...I feel like I am getting somewhere in the search:) This is great....why didn't I find allnurses sooner LOL!!!

Ya'll are great:)

[Gompers, BSN, RN]

We have two kinds of carts on our unit. In the feeder-grower area, we have a cart that is stocked and sealed by pharmacy - they trade it out every month to make sure there are no expired meds. We have very very rarely had to open this cart, so it's just easier to have one like this so that we don't have to check it everyday.

The other carts on our unit are checked EVERY SHIFT by an assigned nurse, and there is a clipboard on each one where the nurse can sign off that it's been checked for that shift. There is a plastic lock you use to close the cart after checking it, and if you are the one to break it open then you are supposed to restock and relock it by the end of the shift. We have a laminated list on top of each cart listing exactly what is in each drawer. This helps both when you're restocking and looking for something during a code. We are responsible for stocking and locking it, but honestly while it is a chore sometimes it really does help a lot when we DO have a code. We are all so familiar with the insides of those carts that we instantly know where to look for supplies when time is precious. We have meds in there as well - epi, atropine, sodium bicarb, narcan, phenobarb, calcium gluconate, and saline bags. These things are packed with everything you could possibly need for a code, from intubation and chest tube supplies to portable warmer matresses and repogle tubes. When we have a baby coding or near coding, we'll roll the cart to that bedside and usually have everything we need right there except for narcotics and paralytics. There is a code sheet clipboard where you just fill in the chart: what time, what the vitals were, what meds were given and how much, what interventions were done, who was participating in the code, etc. We usually try to get the newer nurses to fill this out with a senior nurse supervising - it's a good way to get exposed to what happens during a NICU code.

Like I said, it's time consuming to have to check these carts every shift, but whenever we have a code we are thankful that we have them and how well organized they are. I can't imagine having emergency meds locked up in the Pixis unless it's the kind of machine where you can just swipe your ID and it opens rather than having to type in a username and password - funny how your hands seem to shake during a code situation?!?!

Because we check and restock these carts so often, we also use them for other emergencies even if they're not true codes, like unplanned extubations, because it's so much quicker to get the supplies to the docs right away so no time is wasted in helping the baby, and THEN go get replacements for the cart.

[pooh54]

NRP has some great code sheets!