ACLS? Pedi CVICU

[Julia77063]

I have been a nurse for going in 11 year and have worked with adults in SICU and ER. I now work in a well known Pedi CVICU who care for quite a few adult patients that have had previous congenital heart surgeries that come back for things like valve replacements or just revisions. I let my ACLS lapse because they wouldn't pay for it or even agree to give me time off to take it. I has been times when a 40-50 years old goes into a funky rhythm or codes and the damn dr does know the dose for vasopressin or that the rhythm is A-flutter and they are about to push adenosine. This really worries me; I know he algorithm but the others don't and the Drs don have ACLS. We take their money to care for them but we aren't certified to care for them as the adults they are. I tried to find research on this but was unable to to try and make a change before we have a sentinel event; as our unit usually does things in reaction. Any advise/comments?

[NotReady4PrimeTime, RN]

I now work in a well known Pedi CVICU who care for quite a few adult patients that have had previous congenital heart surgeries that come back for things like valve replacements or just revisions... times when a 40-50 years old goes into a funky rhythm or codes and the damn dr does know the dose for vasopressin or that the rhythm is A-flutter and they are about to push adenosine. I tried to find research on this but was unable to to try and make a change before we have a sentinel event; as our unit usually does things in reaction. Any advise/comments?

That's more than a little frightening, Julia. Flutter isn't even remotely similar to SVT! Vasopressin is part of the PALS algorithm so why they wouldn't know doses is a bit odd. The reactive-vs-proactive approach is all to familiar to me, as is the situation with your ACLS - my PALS will lapse soon for the same reason. Sentinal events? Who needs that? My advice - do your own research. Pick a time frame, say 6 months. Keep track of the adult patients admitted to your unit, their RFAs, any complications during their stay and their outcomes. See if you can identify common themes that suggest knowledge gaps then make a proposal that the unit provide ACLS training for the doctors and a select group of nurses who will be assigned to those adult patients. If you frame it in a patient safety-patient satisfaction perspective the powers that be will be more receptive.

[umcRN, BSN, RN]

We don't take ACLS or need to have it in my unit. We have asked but the hospital won't pay for it. That being said we have adult education incorporated into our yearly education, we also have adult specific code sheets and I don't think any of our doctors would struggle with rhythms, not that I have ever seen anyways! We will sometimes have an issue where a new fellow will place adult med orders in by the standard child mg/kg dose but between the nurses and the pharmacy checking doses it's typically found before it reaches the patient. I haven't heard yet of any adult dose related med errors in my two years in the cicu and my unit is very good about sharing info from incident reports so that others won't do the same thing.

[Julius Seizure]

Seems common for docs not to be required to have things like ACLS or PALS. I carry both, as do most of my fellow PICU/PCICU nurses.