teaching "codes" to med/surg

elthia · Sep 11, 2005

howdy, I'm new to the site but 'old' to nursing. been in ccu/icu for 18 years though i hate to admit I'm that old. Nasty habit of saying yes to everyone (may explain my 6 kids :chuckle ) I was roped into teaching our med surg floor how to best handle a "code" on the floor prior to the 'team' arriving. now i know things are handled differently in different units. So, my question or concern is 'what is the key component(s) I should teach these poor souls without totally overwhelming?" The first of four classes is in 2 days so I'm back to "nursing school" cram session! I've enjoyed the forum so far...the stories are great...even if I just got off the shift from #@ll!! I'll have to think on some from my past...I know there is alot. thanks!!!

The first RN in the door takes charge, gives the order to call the code.The person nearest to the crashcart takes it to the room. The pads go on the pt WHILE the patient is being turned for backboard placement. Then PULL the bed from the wall so RT can get at HOB. The second RN or LVN starts 2 large bore IV's, and starts bolusing NS. The CNA assists family, and does crowd control, and then returns to room with patient's chart, OR has someone else bring the chart in. The first RN (charge) should have the ambu bag and intubation tray at HOB, does rescue breaths. LVN and RN perform CPR and use AED if necessary. By this time the code team should be there, the ACLS nurse takes over the IV"s, the charge RN turns over ambu bag to RT and the charge RN becomes the "recorder". 99% of the time the code team will be there before the AED is used to shock, but remember, most facilities do allow a BCLS nurse with AED competencies to "shock" up to 3 times. Also, most facilities will allow a BCLS RN push ACLS meds under a MD"s verbal order during a code, just in case there is no ACLS RN available.(please check your facilities policies).

Also, unless you are a member of the code team, or are the charge RN, once the code team arrives you can leave the room or run errands...it gets very crowded very fast, especially at teaching hospitals.

See if you can get a teaching crashcart and dummy from education, and have the staff walk through the motions, and then discuss their performance and concerns. Also, leave the cart there for a few days, most nurses on the floor ARE NOT familiar with where the meds are on the crash cart, and would appreciate the chance to look in the cart, but can't because the carts are kept locked.

Tweety, BSN, RN · Sep 11, 2005

I think med-surg nurses can handle teaching on any level, so don't worry about those "poor souls". Perhaps you've been in CCU too long, but med-surg nurses are no dummies and aren't going to be overwhelmed. :)

I would just stick to the basics, get the crash cart, get the oxygen on, start CPR, make sure there's an IV, someone do the documentation, put the monitor leads on. By then the mighty code team should arrive and rescue these poor med-surg nurses and tell them what to do. LOL (Just kidding)

How long is it usually before the code team arrives? In our facility it's usually about 60 to 120 seconds, but it does help to have some of the above stuff done, or started.

Good luck. Welcome!

IseeuCCRN · Sep 12, 2005

sorry if I touched a nerve...let me guess, you are med-surg nurse? I believe the problem we are encountering is our 'institutional exclusive' I don't doubt all are capable teaching....not necessarily learning. We are our own worst enemy. Our Icu is all-inclusive in the way that we take all cardiac, neuro, trauma, med\surg...lately have been getting alot of overflow patients so I've made many phone calls to the "med-surg" guru's for some very basic questions that I have just never dealt with. Sure, I can run an LVAD, IABP, CVVHD...but give me a CPM machine and I am totally befuttled...and yes perhaps I have been in CCU?ICU too long...It has been a rough weekend there...we received 3 transfers from the med-surg gals...one overmedicated with resp. compromise, one with an AMI evolving over a 12 hour night for which he was told the crushing chest pain was probably related to his lami fusion....oooooh was he pissed! hey, #@%$ happens...we are all on the same team here.

I think med-surg nurses can handle teaching on any level, so don't worry about those "poor souls". Perhaps you've been in CCU too long, but med-surg nurses are no dummies and aren't going to be overwhelmed. :)
I would just stick to the basics, get the crash cart, get the oxygen on, start CPR, make sure there's an IV, someone do the documentation, put the monitor leads on. By then the mighty code team should arrive and rescue these poor med-surg nurses and tell them what to do. LOL (Just kidding)
How long is it usually before the code team arrives? In our facility it's usually about 60 to 120 seconds, but it does help to have some of the above stuff done, or started.
Good luck. Welcome!