Nursing Edition: What to do in a code?

January 30, 2019

This post is sponsored by RQI. 
As a nurse, we are often placed in some of the worst scenarios. I know when I was working on the floor, it was very heartbreaking to be taking care of patients who were DNR/Comfort measures. 

For those of you who do not know, this means that these patients were preparing for death. As a nurse, my main job at this point was to keep them comfortable with a morphine drip and allow the family the space to say their last goodbyes. Like all terrible things, there is no way to predict when they will occur. The same goes with a DNR/Comfort measure patient...I had no idea when they would pass and had to remain respectful when I explained this to family members.

If you ask me how my experiences were in my two short years of being a floor nurse, I would say that I was very lucky. I had a handful of rapid responses, but never a true code blue. I had participated in a few on the floor, but none where it was my patient. Nonetheless, code blues are downright terrible. The moment passes in a blur and you start to wonder what you could have done differently.

One terrifying thing for me as a nurse was that it had been a while since I had taken a BLS class. And how much do you really remember from a short few hours class (less than 4 I believe?!). And to top it off, it is a skill you do not even renew every year. After my first year on the floor, I signed myself up on my day off to obtain my ACLS. It gave me a little bit more confidence, but since it was not something I saw every day or every week for that matter, I quickly forgot the algorithm. (Being ACLS certified was not a requirement for my floor.) According to the American Heart Association, it takes three to six months for your CPR skills to deteriorate following this training. 

If you keep current on the news, you know that the American Heart Association places high importance on the quality of CPR. More specifically, I am talking about the chest compressions! In the last few years, I am sure you have seen these fancy hands-only CPR kiosks that have been popping up in airports. But have you heard of the Resuscitation Quality Improvement (RQI) program, co-developed by the American Heart Association and Laerdal Medical? The program's top priorities are to improve patient safety and outcomes and to increase staff CPR competency and confidence to deliver high-quality CPR. 

This month, RQI Partners-LLC, a joint venture partnership between the American Heart Association and Laerdal Medical launched RQI 2020, a hopeful beginning to a new standard for the medical profession in terms of resuscitation and high-quality CPR. This new program was introduced after last July's call for a shifting of resuscitation practice from course training once every two years. RQI 2020 sets forth a new platform for "low-dose, high-frequency" hands-on CPR quality improvement sessions in 10 minutes every 90 days, verifying CPR competency. 

The program is technology based alongside hands-on improvement. RQI stations are placed on floors with 24/7 access. Unlike current standards, RQI delivers quarterly feedback as well as coaching to improve your competency and confidence. Poor quality CPR is a preventable harm and according to the American Heart Association, from more than 200,000 cardiac arrests, less than 26% survive. 

Nearly 400 U.S. hospitals have adopted the RQI program in an effort to better prevent deaths from cardiac arrests. But, if your hospital has not jumped on board, raise the issue to them. 

For more information about RQI 2020's program features and benefits, visit RQI here.

Now here is what to do in a Code Blue:

If you are in the room (first responder), then it is critical that you call for help. If possible, make sure the patient is on a flat surface. Check for a pulse. If there is not one, start good quality compressions as soon as possible. By now many hospitals have "code teams" that usually consist of critical care nurses, an intensivist, respiratory therapist, shift director, pharmacist and transports just to name a few. This means that when the team arrives your role becomes more of that of an information desk. You will be providing the history of what lead to this moment, medications that may have been administered recently, important past medical history, etc.

If you are another team member responding to the code on your floor, your role is support staff until the team arrives. Make sure that the code cart is nearby (for rapid response calls) or in the room. This next part can happen all at once if you have multiple supports or can happen one after another. You want to apply the defibrillator pads to the patient and turn on the AED. Also, if possible, place the backboard under the patient. Lastly, make sure you have a working IV line.

During a code, security and other ancillary staff come to support as well. Security is great at maintaining crowd control and helping the transfer. Chaplains and social workers are also amazing at providing emotional and spiritual support to the patient's family during this time.

Always remember that you are not alone in these situations. It can be a tense time for everyone and try your best to keep your emotions under control and communicate clearly. When the time is done, take a moment to collect yourself apart from documentation or returning to patient care.

As nurses, we have a duty to protect our patients. Get involved and participate in mock codes as often as possible. Also, keep current on CPR requirements or new up and coming standards like RQI.

I pray that you never have to use these skills, but it is always better to be prepared.

Hope this helps!

If you’re interested in learning more, you can visit RQI Partners.
Check out RQI’s Lifesaving Solutions page: here.
Become an RQI Lifesaver: here

#RQIsavesLives #RQI2020

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