Paitent Coded; All Went Poorly

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Today I responded to the most pitiful code ever. Keep in mind that I work at a LTCF. Here's a list of what went wrong during the code.....

1. The crash cart was not stocked, yet the night nurses have been initialing that it has been fully stocked for the past two weeks. I attempted to hook up the suction machine before discovering that there was no tubing or yankauers in the drawer.

2. 'Code Blue' was not announced over the external paging system. I wouldn't have known about it if I didn't spot a couple of people running to a particular patient's room.

3. A bunch of people were standing around in the patient's room with their hands in their pockets, doing absolutely nothing. At least they could have offered to take over the task of the chest compressions, since our hands and arms tend to become exhausted.

4. The patient coded during the lunch hour when the majority of the nurse managers and other employees had left the building to dine at restaurants.

Any questions, comments, or opinions on this matter? Do you think I'm being overly critical? By the way, the code was unsuccessful (of course).

That really bothers me about the crash cart also. It does not take that much time to check it and make sure it is correct. So many people cutting corners today with peoples lives at stake, really a shame.

Specializes in NICU, Infection Control.

"...This should be made into a comedy skit!!!!!!"

Get in touch w/Ted!

In one of my career "incarnations", I was a supervisor on nights--moderate sized University teaching hospital, med students, etc. I noticed (after going to several codes) that whether the pt survived had very little to do w/how the code ran. (None of them were quite as bad as the ones you all have described in LTC.)

We could have a picture perfect code--nurse assigned to the pt STAYED in the room (a biggie, cuz s/he was the only one who had a clue as to what was going on w/pt @ that time), the O2 and suction BOTH worked :eek:, when the code team showed up, RT was there and BLS was already going. All that didn't matter. If the pt was going to die, s/he died.

Conversely, numerous malfunctions of people, equipment, whatever, could impede progress, and the pt would still make it @ least to the ICU.

I made it a point if I saw a med student standing there to direct him or her to do chest compressions. I figured the nurse doing them had lots of other things she could/should do, and the student could see everything that happened from up there!

Specializes in Geriatrics, Cardiac, ICU.
Wow, this brings back memories! Over a year ago, when I had just started this job (it was actually my second day here) I had the most inept code happen...

First of all, my office is on the exact opposite side of the facility from where the code was. I was on the phone trying to find someone to cover a callout, when there was a knock on my door and a CNA told me they thought "Mrs. Smith" had passed. I said "IS SHE A CODE?" The CNA did not know. Now, mind you, they could have paged me overhead, but didn't because it was nighttime. (Needless to say, I made sure they all knew the definition of "emergency" and when it is okay to page overhead after that!) So I run over to that side of the facility, the LPN is sitting behind the nurse station, calmly. I said "Is Ms. Smith a code?" She looked at me blankly and said "I don't know, I assume she's DNR." I grabbed her chart, flipped it open- she was a full code. I hollered at the CNA to call 911 while I ran into the resident's room, pulled the pillows out from behind her head and tilted her head back. No breathing/pulse. Now the crash cart is here, and the backboard is missing. Great. So I had the LPN help me yank the headboard off her bed and put it under her, I start compressions while the LPN reaches for the Ambu bag. Guess what? It's missing. I throw my supply room keys at the CNA and she runs to get one, the LPN puts it together and tries to hook it up to the O2 tank. Tank's empty. I send another CNA after a new O2 tank, while the LPN tries to force room air into her lungs with the Ambu. There was mucus blocking her airway. I grab for the suction, and the tubing was missing. By now I was ready to cry. I'm still doing compressions, and wondering where EMS is, when someone says "Noone went to let them in." WHAT?!?!?!? So someone goes to let them in (the facility can only be opened by an ID badge at night) and fails to let the remaining two members of the EMS team in. The ones with the intubation kit.

Needless to say, the first thing I did after that was to completely revamp the facility's code policy, with daily crash cart checks and monthly drills. I'll never forget that nightmare. And no, the resident did not survive...

Umm, can't the LTC facility be sued for nor properly executing a code? ( Not saying it was your fault, esp. since no equipment was available).

I work at a large 205-bed LTCF and none of our CNAs are BLS-trained or certified. All of the aides should know CPR since they're often the first people to spot unconscious patients and, therefore, can respond within that first critical minute.

When I worked in LTC (also where I did my CNA classes) we were told by the DON that CNA's were not to be trained in CPR. You might check with the DON, that might be why the CNA's didn't know CPR. Never explained when I protested why we could not be CPR certified.

Personally, if you are working in a healthcare setting, you better know your ABC's.

Specializes in Utilization Management.
When I worked in LTC (also where I did my CNA classes) we were told by the DON that CNA's were not to be trained in CPR. You might check with the DON, that might be why the CNA's didn't know CPR. Never explained when I protested why we could not be CPR certified.

Personally, if you are working in a healthcare setting, you better know your ABC's.

The most likely reason is money, because if a facility requires something, they usually have to pay for it.

So they tell you that you don't need it.

:trout:

Pretty unrealistic, if you ask me.

My facility does not pay for me to have ACLS, but I get it because I feel more competent and comfortable having it. The bonus is that I actually understand what's going on in a Code and even better, what ought to be going on.

Check on the LTC/ Geriatrics board...lots have been posted before on this subject.

As far as requiring the facility to have supplies....yes they should be held responsible. Years ago I tried to put together a crash cart and got a lot of resistance. First off, they wanted it to be named "Emergency cart" Crash cart sounded like we should be responsible for a "code" In LTC, the "code" isn't anything like what is done in acute care facilites.

What is protocol in most facilities I've worked at is #1 know the residents status....#2 Call 911...#3 Start CPR. Now if you are lucky, you have the ambu bag, face mask, o2 handy. If you are really lucky, you have another nurse or aid who knows how to use them and isn't in a fit of panic.

As far as getting more supplies.....ha ha. The more you have, (AEDs, etc) the more you are liable for...or so I am told. :madface:

In reality....most ltc have few full code pts. Some even have policies on admit that tell the resident they will call 911 and thats about it if you want a code.

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