Please help...mini swat type policy

Straydandelion · May 14, 2009

The only one I have experience with is an overwhelmed staff due to possibly violent patient/family typically that code would call security/supervisors/certain techs etc. It seems the "overwhelmed" staff needs to be defined a little better and who exactly would be expected to arrive otherwise you are likely to have too many out of curiosity, or too few show.

oramar · May 14, 2009

The only one I have experience with is an overwhelmed staff due to possibly violent patient/family typically that code would call security/supervisors/certain techs etc. It seems the "overwhelmed" staff needs to be defined a little better and who exactly would be expected to arrive otherwise you are likely to have too many out of curiosity, or too few show.

You make good points here but I would like to add that I am very impressed with the people that care enough to consider something like this.

kdfranzen · May 14, 2009

We already have a code strong in place for the violent patient.

We would like to add another type of code for nursing support.

Here is the example of the situation that prompted this: The hospital was in a code 3 capacity (basically patients in every bed and all holding areas). We had 8 tele patients remotely monitored on a medical unit. One of the tele patients seized and a CT scan showed a head bleed. There were no ICU bed and the patient needed to be transfered to a neuro hospital. There were ongoing issues with this nurses other 3 patients, and she needed assistance that was not given by the other floor nurses. Next time we have this happen we would like to call a nursing support "code" and responders would be nurses from various areas who are not busy and can lend a hand i.e calling family, copying chart, running for meds, sending off stat labs, and assisting with the other patients included in this assignment until the primary nurse can reassume their care.

Jolie, BSN · May 14, 2009

A nice concept, but I don't know of any unit so well staffed that they could offer up a staff member to go essentially pick up an assignment on another floor.

This sounds like an indication for nursing administrative support, including the nurse manager of the unit, clinical educator, nursing supervisor(s) and the "suits" who happen to have RN after their names. Back in the "olden days," we didn't need to call a special code to get these people to respond. I guess times have changed.

Please keep us posted. I'm genuinely curious as to how this will work.

mama_d, BSN, RN · May 14, 2009

We already have a code strong in place for the violent patient.
We would like to add another type of code for nursing support.
Here is the example of the situation that prompted this: The hospital was in a code 3 capacity (basically patients in every bed and all holding areas). We had 8 tele patients remotely monitored on a medical unit. One of the tele patients seized and a CT scan showed a head bleed. There were no ICU bed and the patient needed to be transfered to a neuro hospital. There were ongoing issues with this nurses other 3 patients, and she needed assistance that was not given by the other floor nurses. Next time we have this happen we would like to call a nursing support "code" and responders would be nurses from various areas who are not busy and can lend a hand i.e calling family, copying chart, running for meds, sending off stat labs, and assisting with the other patients included in this assignment until the primary nurse can reassume their care.

Management should be having a conversation with those who did not step up to the plate on that floor. There is NO excuse for that. I don't care how busy we are on my unit, that kind of behavior is not tolerated; management doesn't even need to get involved b/c we take care of discussing that kind of lack of professionalism and respect ourselves. We've had situations where a nurse had a code, a rapid response, a discharge, and three new admits all in one shift (on nights, with no secretary or transportation to help)...and you know what? When another nurse's patient started crashing, we dropped what we were doing to help her out and jumped right in, even though we were all overwhelmed ourselves. Then we all pitched in to clean up the collective mess and chaos that was left behind. It's called TEAMWORK. And I think you can't have a stellar unit unless you've got it. Sorry if this sounds a little scathing...on second thought, no, I'm not sorry. It should be scathing. It really makes me extremely angry to hear about situations like this.

Edited to add:

There is a difference, of course, in a legitimate crisis situation such as you describe and the incompetent who just can't get their crap together and expect everyone else to do their stuff for them. Those people are another thread entirely.

kdfranzen · May 14, 2009

I completely agree regarding the teamwork issue. However, when we had our analysis meeting about this situation the house supervisor and charge nurse both had various reasons for why they were basically not involved in the situation. The nursing administrator was the one who suggested this new code implementation, and I've been placed in charge of trying to set it up. I'm hoping it will also cut back on some of the lesser Clinical Response codes. We had one a week ago where they simply needed lift help getting a patient back in bed.

Jolie, BSN · May 14, 2009

I completely agree regarding the teamwork issue. However, when we had our analysis meeting about this situation the house supervisor and charge nurse both had various reasons for why they were basically not involved in the situation. The nursing administrator was the one who suggested this new code implementation, and I've been placed in charge of trying to set it up. I'm hoping it will also cut back on some of the lesser Clinical Response codes. We had one a week ago where they simply needed lift help getting a patient back in bed.

I'm sorry to be so skeptical, but this additional information only serves to convince me that the entire purpose of this exercise is to shield your nursing leadership (and I use that term loosely) from any responsibility to actually do their jobs and assist in emergency, high-census, high acuity situations.

Frankly, it disgusts me. I would not participate in finding a way for them to shirk their duties to the patients of the institution and their staff nurses. But then again, I don't need your paycheck.

Best of luck to you in this minefield.

mama_d, BSN, RN · May 15, 2009

I completely agree regarding the teamwork issue. However, when we had our analysis meeting about this situation the house supervisor and charge nurse both had various reasons for why they were basically not involved in the situation. The nursing administrator was the one who suggested this new code implementation, and I've been placed in charge of trying to set it up. I'm hoping it will also cut back on some of the lesser Clinical Response codes. We had one a week ago where they simply needed lift help getting a patient back in bed.

First off, there's no excuse for the house supervisor to not be involved in a transfer to another hospital, to help with coordination, if needed. And there's no excuse for the charge nurse to leave that nurse and her patients without assistance...if she was too busy, it should have been delegated to others to pitch in and help.

Although, again, the mere fact that this situation took place the way you describe baffles me. I always have said that I work with the best bunch of people you could find, but didn't realize that there were places where nurses were left floundering like this with no back up.

I guess that I should be aware of it though, on second thought...our management came up with a (stupid, I think) idea to show what nurses were drowning and needed help. My questions regarding the need for this waste of time were firstly, why wouldn't someone open up their mouth and ask for help, and secondly, how could co-workers not notice and pitch in if something like that was going on? Again, not including the perpetually clueless and entitled in this; the only way for them to learn how to cope is to eventually have to deal with it on their own. The only answer I got was that "not all units work together like that". So why not address the fundamental problem of lack of teamwork, instead of implementing yet another time wasting policy?

daniedi77 · May 15, 2009

In my hospital we have a code Purple, which is a rapid reponse. This calls for 1 ICU or ER RN other then pt;s nurse, 2 resp. therepists, house sup, and phlebotomist, no doc. It has been great ever since we implemented this last year. We use it from resp distress to patient falls. It includes almost anything that falls below a code blue. We have schedules for who the team includes each day and we are required to respond immediatley or face write-ups. Works great and it often prevents alot of code blues.

MichelleB34 · May 15, 2009

We already have a code strong in place for the violent patient.
We would like to add another type of code for nursing support.
Here is the example of the situation that prompted this: The hospital was in a code 3 capacity (basically patients in every bed and all holding areas). We had 8 tele patients remotely monitored on a medical unit. One of the tele patients seized and a CT scan showed a head bleed. There were no ICU bed and the patient needed to be transfered to a neuro hospital. There were ongoing issues with this nurses other 3 patients, and she needed assistance that was not given by the other floor nurses. Next time we have this happen we would like to call a nursing support "code" and responders would be nurses from various areas who are not busy and can lend a hand i.e calling family, copying chart, running for meds, sending off stat labs, and assisting with the other patients included in this assignment until the primary nurse can reassume their care.

I absolutely agree with the others on this thread that the nursing supervisor and charge nurse should have been involved. On the medsurg unit I worked on when you have a patient that is crashing or you have an impossibly busy assignment your coworkers help you. If everyone is truly busy our nurse manager would get approval from the supervisor to try and call a nurse or nurses in early. There have been a few occasions when the hospital was in a true crisis that a few nurses in administration have done patient care. On the maternity unit that I work we sometimes have to be on call for backup. It depends on the staffing for that day, the patient census, and the experience of the staff on (more so on the night shift because we have had a lot of new nurses and backup is not always readily available on nights). When you're on call it's usually only for four hours at a time, unless you want to do more. It's only once or twice every two weeks and sometimes noone has to be on call. We have a few perdiem nurses who often sign up for the on call. We get paid $3 per hour that we are on call. So that might be one option.

We also have a rapid response team. If your patient is having any change in condition, minor or major, that you feels needs immediate attention and the doctor is not readily available you call the rapid response team. This is made up of the nursing supervisor and/or one or two ICU trained nurses, and a respiratory therapist. They have standing orders that they are allowed to carry out. ie ABGs, EKGs, labs, etc. They also carry a desiganated cell phone with them so they can call the doctor right from the room with the patient condition and what has been done and obtain further orders if needed. They will stay until the patient is stabilized or transferred if need be. One time that I called them was for a patient that had a lap chole the day before. The patient had a low bp and her O2 had to be increased to 4 liters. Her bp wasn't responding to the fluid bolus. I can't remember for sure but I don't think the doctor was calling me back in a timely fashion. The patient was alert and oriented and felt fine otherwise. The respiratory therapist and I felt something was going on with the patient so we called a rapid response. The patient ended up being transferred to the ICU and was on a medicated drip to maintain her bp. One of our nurses in the education department who is in charge of the team has said that we have prevented a number of codes by calling the team for changes in condition that need attention. Hope this helps. Keep us posted.