I have had several situations from work bother me for a day or two, but this one has stuck with me for weeks. I was working with a Dr. I have never worked with before, I am a fairly new nurse. I had a pt. who seemed to me to be circling the drain. I politely mentioned this fact to the Dr. and he ignored me. 30 min. later the pt. was getting worse--she seemed to be septic, BP going down, breathing faster, cool extremities, unable to obtain accurate spO2. I took the liberty of discussing with the pt. if they would want everything done if the pt. were to die and they said yes. I told the Dr. I was really worried about this pt., showed him vital sign trend--still nothing. I asked if I could start antibiotics and blood cultures, he agreed. BP still going down, this pt. looked like she should have been intubated 20 minutes ago, I got the Dr. to come look at pt., still nothing. I prepared the room for a code, got an order for dopamine after bothering the dr 6 or 7 more times. Well, to make a long story short the pt. died. I was pretty much standing there with BVM in hand waiting for it because I was positive she was about to die. I had already called respiratory as well. When she did die, I ran the code since no one else would take charge, I have only been in a few codes (and ACLS) so I can't say that things went textbook perfect.
I just keep going over every detail of this case in my head over and over and over again. I shoud have had someone defib her earlier since the Dr. wasn't having anyone do anything, I should have gone to my charge nurse to tell her that my pt was dying and no one is listening to me. I should have gone to talk with the family after the death but I chickened out. I know that I did the best I could possibly do with what knowledge and ability I have, but I can't help but think that we could have saved this lady if someone would have just listened to me. I should have screamed at the Dr. or something, but I guess being new I didn't want to be the boy who cried wolf. Maybe she would have died anyway, but the bottom line is, I don't think we did everything we could have done for her for an hour before she died.
Did she call a code and no one came? That is pretty negligent on "their" part isnt it? Why does she feel she needs comforted. I would still be raising #$^*
Did I miss something eairler?
He never said he called a code and no one came. He said he ran the code. Meaning no one else stepped up, like the ED doc, to run it.
O sorry, I did not realize you could run a code without calling one. I am not trying to be funny, I work for the VA and we would call a code. If not the pt would be DNR. Occassionally in the ICU we jsut code for a while then call it. But it is much eaiser to have pharmacy on hand. Do other hospitals have codes in the ER without calling a code?
In the hopital I just left, we had a team that we could call if the patient just didn't seem right. I'll be darned if I can remember what the team name was, but it was part of the 100,000 lives saved program. Maybe you should mention this to the department heads for further follow up. This is something that was 4 months or so in the making and was implemented flawlessly.
Jen, is this the same thing as a "Rapid Response Team"? I've heard about them recently while doing hospital rotation as a CNA. These are people you call pre-code, and if they can't help and pt deteriorates, one calls an actual code?
Wow, lots of confusion, I guess everyone does things differently.
When you say "call a code", do you mean to summon a code team? In the ED where I work, we code the patient. Usually a doctor runs the code, ie: interprets rhythms, calls for drugs needed, intubates, places central lines if needed, etc. The nurses perform CPR, adminsister meds (Emergency meds are kept in the ED), obtain peripheral lines if able, operate the defibrillator if called for, etc. Most of the time a respiratory therapist is there too, and they may intubate if the doc is doing something else, and they set up the vent or bag the patient. So we code the patient with our own resources, we don't summon a separate code team.
This is from the original post: "...I had already called respiratory as well. When she did die, I ran the code since no one else would take charge..."
I took it to mean there were other staff present, but it was unorganized, and the OP had to take charge and run the code. (The MD should have been there running the code)
O and sorry I keep calling him, her.
Also from the original post: "but I guess being new I didn't want to be the boy who cried wolf"
I think that is what had me thinking it's a male nurse, but you could be right, might be a female! Hopefully the OP will come back and clarify! :chuckle
A new nurse in the ER running a code while the doctor is showing no interest in saving this patients life?? Is that what has happened? Sounds criminal to me, just horrible! I would look for another place to work.
yea steel city, I must be missing something here. Maybe the doctor should have been cardioverted. Like the fly in the superbowl commercial. GO COLTS!!!
O sorry, I did not realize you could run a code without calling one. I am not trying to be funny, I work for the VA and we would call a code. If not the pt would be DNR. Occassionally in the ICU we jsut code for a while then call it. But it is much eaiser to have pharmacy on hand. Do other hospitals have codes in the ER without calling a code?
In the ERs where I have worked, we didn't announce codes. We ran our own. We just called lab and respiratory stat if they were out of the department for some reason.
I have had several situations from work bother me for a day or two, but this one has stuck with me for weeks. I was working with a Dr. I have never worked with before, I am a fairly new nurse. I had a pt. who seemed to me to be circling the drain. I politely mentioned this fact to the Dr. and he ignored me. 30 min. later the pt. was getting worse--she seemed to be septic, BP going down, breathing faster, cool extremities, unable to obtain accurate spO2. I took the liberty of discussing with the pt. if they would want everything done if the pt. were to die and they said yes. I told the Dr. I was really worried about this pt., showed him vital sign trend--still nothing. I asked if I could start antibiotics and blood cultures, he agreed. BP still going down, this pt. looked like she should have been intubated 20 minutes ago, I got the Dr. to come look at pt., still nothing. I prepared the room for a code, got an order for dopamine after bothering the dr 6 or 7 more times. Well, to make a long story short the pt. died. I was pretty much standing there with BVM in hand waiting for it because I was positive she was about to die. I had already called respiratory as well. When she did die, I ran the code since no one else would take charge, I have only been in a few codes (and ACLS) so I can't say that things went textbook perfect.
I just keep going over every detail of this case in my head over and over and over again. I shoud have had someone defib her earlier since the Dr. wasn't having anyone do anything, I should have gone to my charge nurse to tell her that my pt was dying and no one is listening to me. I should have gone to talk with the family after the death but I chickened out. I know that I did the best I could possibly do with what knowledge and ability I have, but I can't help but think that we could have saved this lady if someone would have just listened to me. I should have screamed at the Dr. or something, but I guess being new I didn't want to be the boy who cried wolf. Maybe she would have died anyway, but the bottom line is, I don't think we did everything we could have done for her for an hour before she died.
Your patient did not die because you were the nurse and you are "fairly new". This pt would have died anyway, because it sounds like your doc was not taking an interest in the patients deterioration. My blame would not be on you but on the non responsive doctor.
Sorry for the confusion. I am a female, and yes I just initiated the code--I actually got the Dr. in the room about 30 seconds before the pt. died because I knew it was coming. He began to intubate I pushed the code button and staff came a'runin as usual, but no one was DOING anything, or "ordering" anyone to do anything so I just took over and started ordering and doing everything myself. Maybe I should go talk to someone about it. All the other docs we have are very, very good, maybe he just made a mistake, or maybe not.
Maybe I should go talk to someone about it. All the other docs we have are very, very good, maybe he just made a mistake, or maybe not.
Good idea! How long have you been in the ED? I'm a new nurse as well in the ED. After I came off orientation, I sat down with my unit educator and my preceptor. We came up with a list of other employees I was turn to as my resource people. My preceptor, of course, another RN I had turned to several times for advice, and one of the asst nurse mgrs. I often times will go to them after a situation, esp if they were there, and say "What did you see that I could have done differently?". If I had a difficult patient, I will ask one to come check my charting- make sure I haven't missed anything important, make sure I have CYA and I am writting a story for later shifts if they need to look thru the chart for info.
Also, was the doc on the unit or were you having to call them? Were you using SBAR when contacting the doctor?
I think we've all had those situations- you look back and realize what happened, what *should* have happened vs what did happen. The most important thing here is to learn from it.
don't beat yourself up over this-it didn't happen because you are new, it happened because dr. x didn't do his job. i had a patient once who was obviously septic, extremely dehydrated, with unstable vs. i notified the md several times of her condition, and after doing that several times with the dr. doing nothing but calling the picu intensivist to give a heads up, i finally went up to him and asked, "are you going to intubate her? because she's going to code soon". after that he was still somewhat dragging his feet, so then i had the cn speak with him, which prompted him to get his butt in gear. i was also fairly new at the time, so maybe he just wasn't as inclined to listen when concerns were coming from me and not the cn (although now he listens when i tell him a pt is going bad)??? i don't know.....the only thing i can think of that you might have done is had the cn speak with the doc, but other than that, it sounds like you did everything you were supposed to and were well prepared. i would definitely speak with you nm about the situation and hopefully you documented all the times you notified the md about your patient's condition.
noc_owl
53 Posts
He never said he called a code and no one came. He said he ran the code. Meaning no one else stepped up, like the ED doc, to run it.