Nurses and Defibrillation

[bobnurse]

It was not long ago when defibrillation was limited to physicians only. One day, nurses said, "why cant we defibrillate, instead of waiting for the doc's to arrive" The docs said are you crazy...Then not long after, they decided to let the medics perform defibrillation out of hospital, and it worked...Patients lives were saved prehospital....Nurses said, "why cant we defibrillate, instead of waiting for the code team to arrive" The docs said are you crazy!! Now the janitors and normal lay people are providing defibrillation prehospital (AED's and PADs System). Floor nurses are saying,"why cant we defibrillate". The docs said are you crazy????

This is a story we tell in regards to defibrillation in the hospital. It amazes me that we allow lay people to defibrillate in the community, but not the hospital trained (ACLS) nurses to provide the same care (floor nurses).

For every minute that passes, you lose a 10% chance of survival in regards to V-fib/V-Tach arrest. This gives you around 10 minutes to restore circulation before death has occurred. So my question is: Why cant floor nurses defibrillate before the physicain/code team arrives? Your looking at realistically a 2-4 minutes response time, after the patient is found. This gives the patient optimally an 80-60% chance of survival if the code is called at the onset of arrest. If the floor nurse could defibrillate, your looking at an 80-90% chance of survival........If you think about it, you have a better chance of survival in some instances going into arrest in front of Dillards at the mall than on the rehab floor of your local hospital.

All Defibs sold today come with an AED mode? So why arent floor nurses allowed to perform BLS? Many of you thought i was going to say ACLS, but remember defibrillation is a BLS function.

I just wanted to get your thoughts and opinions. Also, what if a family member went into cardiac arrest, and defibrillation didnt occur for say 7 minutes post arrest due to 1. Waiting for a code team, then 2. Code team came and reassessed, then defib 7 minutes into it. Now the patient has expired. what is the hospital liability?

Thanks for your replies

[Tweety, BSN, RN]

I hear you Roy, lay people are taught AED use in basic BLS all the time now.

We follow ACLS protocol, if Defib is indicated the nurses do it whether a doc is present or not. But the docs usually arrive along with the code team. We're a teaching hospital and the intern/resident team are in charge of the code, so it's usually a mutual agreement. But the nurses are the ones doing the actual work while the intern just stands and watches the code team.

[traumaRUs, MSN, APRN]

We do in our ER all the time!

[bobnurse]

Many of you are still referencing ER and ICU environments.........Im sure in all ER Departments, nurses can defibrillate....Im referencing the floors....Medical Surgical floors, ortho floors, neuro floors and so forth.......Im a ACLS instructor for our region, and teach at many hospitals, and here in oklahoma, floor nurses cannot defibrillate at many of the hospitals. Typically the ICU charge or ER staff will respond and perform defibrillation as well as secondary survey (intubation, Meds, and so forth). The floor nurses are ACLS....at least the charge as a minimum.....Thanks for your responses.....

[EricTAMUCC-BSN, BSN, RN]

So why arent floor nurses allowed to perform BLS?

Like many others have said I wasn't aware that floor nurses were not allowed to defibrilate and if that's the case it doesn't make much sense.

I just wanted to get your thoughts and opinions. Also, what if a family member went into cardiac arrest, and defibrillation didnt occur for say 7 minutes post arrest due to 1. Waiting for a code team, then 2. Code team came and reassessed, then defib 7 minutes into it. Now the patient has expired. what is the hospital liability?

If this hospital is not meeting minimal standards that other hospitals abide by than they are at risk of getting sued by the family for neglect. However that wouldn't make much of a case.

I could probably teach a monkey to recognize v-fib and light someone up

I agree.

[RE Agent]

It was not long ago when defibrillation was limited to physicians only. One day, nurses said, "why cant we defibrillate, instead of waiting for the doc's to arrive" The docs said are you crazy...Then not long after, they decided to let the medics perform defibrillation out of hospital, and it worked...Patients lives were saved prehospital....Nurses said, "why cant we defibrillate, instead of waiting for the code team to arrive" The docs said are you crazy!! Now the janitors and normal lay people are providing defibrillation prehospital (AED's and PADs System). Floor nurses are saying,"why cant we defibrillate". The docs said are you crazy????

This is a story we tell in regards to defibrillation in the hospital. It amazes me that we allow lay people to defibrillate in the community, but not the hospital trained (ACLS) nurses to provide the same care (floor nurses).

For every minute that passes, you lose a 10% chance of survival in regards to V-fib/V-Tach arrest. This gives you around 10 minutes to restore circulation before death has occurred. So my question is: Why cant floor nurses defibrillate before the physicain/code team arrives? Your looking at realistically a 2-4 minutes response time, after the patient is found. This gives the patient optimally an 80-60% chance of survival if the code is called at the onset of arrest. If the floor nurse could defibrillate, your looking at an 80-90% chance of survival........If you think about it, you have a better chance of survival in some instances going into arrest in front of Dillards at the mall than on the rehab floor of your local hospital.

All Defibs sold today come with an AED mode? So why arent floor nurses allowed to perform BLS? Many of you thought i was going to say ACLS, but remember defibrillation is a BLS function.

I just wanted to get your thoughts and opinions. Also, what if a family member went into cardiac arrest, and defibrillation didnt occur for say 7 minutes post arrest due to 1. Waiting for a code team, then 2. Code team came and reassessed, then defib 7 minutes into it. Now the patient has expired. what is the hospital liability?

Thanks for your replies

If the patient needs to be difibed, then do it. Just think if your family member, or you were the patient, and the nurse stood by waiting for the doc to get there. This is want nurses do, we save lives. If it's not in yor P&P get it in there. The patient comes first.

[unknown99, BSN, RN]

If nurses cannot defib, then why are they teaching us, now, how to use an AED when we renew our CPR for the healthcare provider?

[Karen]

We have AED's on all the floors and use them. It's part of BLS training.

[bobnurse]

I know somebody out there works at a hospital where they can only provide basic care until a code team arrives. No Defib

[flashpoint]

I can't inagine not being able to defibrillate...our hospital is getting AEDs to use in addition to the regular defibriallator and they are considering requiring ALL employees to be trained to use the AED...

[bobnurse]

I can't inagine not being able to defibrillate...our hospital is getting AEDs to use in addition to the regular defibriallator and they are considering requiring ALL employees to be trained to use the AED...

It happens

[CA CoCoRN, RN]

I've never been at any hospital where I couldn't defibrillate if the rhythm called for it.

[rstewart]

It is very common.......Im talking outside the ER and ICU......Ive seen PCCU's where the nurses could only provide BAsic life support.....No defib.......My wife works on a step down where they take drips and vents and so forth......But no defib.....Only airway and cpr.........Here in oklahoma, many floors (med surg, neuro, renal, etc....) are like that.....

I also practice in Oklahoma. Until recently our facility did not permit floor nurses to defibrillate. I always found this odd since we had many floor nurses who had completed a course in ACLS.

In any event we have purchased Lifepak 20s (with an AED mode) for all of our carts. Now early defibrillation by floor nurses is an expectation. Time marches on....even in Oklahoma.