NUR 213 Teamwork and code roles

Teamwork has been found to be one of the key initiatives within patient....

...safety that can transform the culture within health care. Patient safety experts agree that communication and other teamwork skills are essential for the delivery of quality health care and for preventing and mitigating medical errors, patient injury and harm.

Who are the code team members?

2 Compressors. Airway Manager [often respiratory therapy]. Defibrillation Manager. •Crash Cart Manager [medication administration]. •Code Team Leader [whoever is most qualified]. •Recorder.

Code team rules for the Airway manager.

2 breaths every 30 compression's. Want to see chest rise with each breath. Be prepared for intubation.

Most death occur within the first ___________after resuscitation.

24 hours.

With shock energy for defibrillation, what should the jewels be for monophasic?

360 J

What is the normal body temperature in Celsius?

37 degrees Celsius

The Mobile RRT team responds 24/7 and expected to respond within?

5-10 minutes either via phone or face to face [F2F].

When will patient start to show signs of deterioration before actually coding, how many hours before?

8 hours.

Code team rules for the Defibrillation manager. What training do they have? What do they know to recognize? What do they say? What if ACLS individual is not available.

ACLS trained. recognize shockable rhythms such as pulseless VT and VF, we don't shock PEA or asystole. Before shocking, they will say: "I'm clear. You're clear. Oxygen clear" and then deliver shock. Can switch to AED mode if ACLS individual is unavailable.

Image for pads that circulate cold water to bring down temp.

Able to control how fast or slow body temp is changed

Image of similar to central line, has another catheter inside that circulates cold fluid to decrease temp by cooling blood. Able to cool fast and efficiently, but downfall is it's invasive.

Able to control how fast or slow body temp is changed

The RN should call the RRT if the patient has developed acute change is what?

Acute change in mental status.

During an adult cardiac arrest, what medication is given for pulseless V-tach or V-fib [med is an antiarrhythmic]? What is the first dose and what is the second dose?

Amiodarone [for V-fib and pulseless V-tachy]. 300 mg first dose, second dose can 150 mg.

Found this on the internet about why we need to monitor electrolytes during rewarming. Need to ask Ms. Beasley why we need to monitor electrolytes.

Because electrolytes shift out of the cells back into the serum during rewarming, frequent electrolyte monitoring is needed during this phase to prevent critically elevated levels. Slow, controlled rewarming allows the kidneys to excrete excess potassium, preventing hyperkalemia. [We worry about dysrhythmias].

What are the major factors that determine survival after ROSC?

Brain injury and cardiovascular instability make survival less.

What are 3 important things about team dynamics?

Clear role and responsibilities. Know your limitations. constructive interventions.

How should we communicate it? 3

Closed loop- read back and verify. Clear messages- concise communication with distinctive speech in a controlled tone of voice, no yelling or shouting. Mutual respect- abandon ego, acknowledge the value of each role, no role is any more important than the other, all roles are equally important.

What type of communication is effective?

Closed loop. Sender says an order, the receiver repeats the order back. The receiver repeats it again after the order is done. Dr. "give 1 amp epi" RN repeats "1 amp epi" before drawing up. RN: "1 amp epi in and flushed the line"

The nurse should call the RRT even if they are just feeling what?

Concerned about the patient.

Code team rules for the Recorder.

Documents entire process. Reminds compressor when to switch. Reminds when last dose of medication was given and when the next should be given.

What does a phlebotomist do during a code?

Draws labs.

With adult cardiac arrest, what is the drug therapy suggested from the ppt slide?

Epinephrine IV/IO dose: 1mg every 3 to 5 minutes. Amiodarone IV/IO dose: first dose: 300mg bolus. second dose: 150 mg.

During an adult cardiac arrest, what medication is given as the first med no matter what the rhythm is? How much?

Epinephrine. 1 mg every 3 to 5 minutes.

What should we know about clear role and responsibilities?

Every member should know their role and responsibilities because without clear roles: -essential tasks are missed. -the task is completed more than once. -not sharing equal duties.

How often is rhythm analyzed?

Every two minutes, which is when compressors switch.

During code cool, what do we expect to see? What do we monitor?

Expect bradycardia. Monitor electrolyte levels.

Code team rules for the Compressor.

First member of the team to arrive. Responsible to start compression's and maintain rate of 100-120. Switch every 2 minutes [5 cycles]. Each compression is at least 2 inches deep.

What are reversible causes of a cardiac arrest? [the 6 H's].

Hypovolemia. hypoxia. Hydrogen ion aka acidosis. hypo/hyperKalemia. Hypo/hyperGlycemia Hypothermia.

What does debriefing improve? Debriefing is? 5

It improves team performance. It is: -Timely. -Respectful. -Specific. -Directed. -Considerate.

What should be communicated? [2]

Knowledge sharing- talk as a team, give a report on what events leading up to the code, SBAR report. Summarize and re-evaluate- when and what medications have been given, when the next dose is due, when to change compressors. Share what has been done and what additional things we can do.

What do we do during targeted temperature management aka cold cool? Make sure the client is..... maintain temperature between... Induced by... Lowers....

Make sure client is comatose because shivering will use up oxygen. Maintain temperature between 32°C [89.6 F] and 36°C [96.8 F] for at least 24 hours. Induce by cold saline, ice packs in the axillary, groin or all over, cool management systems. Lowers metabolic rate to save brain by not using as much oxygen.

Team work is...

Necessary for positive patient outcomes. Recognizing one role is not better than the other and we all rely on the other roles.

The RN should call the RRT for a new onset of what?

New onset chest pain.

Should we try to assess brain function when a patient is hypothermic? What is contraindicated to TTM [target temperature management] aka code cool?

No. Intracranial bleeding.

What O2 range and quality should the RN call the RRT?

O2 <90 or increasing O2 requirements.

The person giving CPR should continue compression's while the defibrillator is charging, but then what do they do?

Once charged, they stop compression's, remove oxygen, the person managing the defibrillator will say "I'm clear, you're clear, oxygen clear" then they deliver the shock. The compressor will restart CPR.

What are the 5 keys to success with a rapid response?

Organizational culture. team structure. expertise [is the key to effectiveness]. communication. teamwork.

Code blue is for what?

Patient has no pulse, no respiration's or has agonal breathing [gasping, labored breathing, accompanied by strange vocalizations and myoclonus].

What are some possible additional code team members?

Pharmacist. Chaplin. Public safety. Phlebotomist. EKG tech.

The RN should call the RRT if a postpartum women has what?

Postpartum hemorrhage.

CPR quality?

Push down at least 2 inches. Push 100-120 time per minute. Minimize interruptions in compression's. Avoid excessive ventilation's. Rotate compressor every 2 minutes or sooner if fatigued. If no advanced airway, compression to breath ratio 30:2.

What RR should the RN call the RRT?

RR <8 or >24.

What is important that is needed to be done quickly with an RRT?

Rapid assessment and rapid intervention.

Code team rules for the Crash cart manager.

Restates drug names before drawing up and giving to medication administration nurse.

What does the bedside nurse provide to the RRT?

SBAR report of the patient. Situation, background, assessment, recommendation.

What SBP numbers should the RN call the RRT?

SBP <90 or >180.

Adult cardiac arrest circular algorithm is?

Start CPR [give O2, attach monitor/defibrillator] and check rhythm- all while doing CPR. If V-fib or pulseless V-tach, we will shock. If no ROSC, then we continue CPR and monitor CPR quality for 2 minutes. At 2 minutes, we recheck rhythm. If V-fib or pulseless V-tachy, we will shock. Continue CPR if there is no ROSC.

What are reversible causes of cardiac arrest? [the 5 T's]

Tension pneumothorax. Tompanade-cardiac. Toxins. Thrombosis-pulmonary and coronary. Trauma.

What is meant by return of spontaneous circulation [ROSC]?

There is a pulse and BP.

Code team rules for the airway manager and compressor if there is an ET tube [advanced airway], what will they do?

They will do continuous compression's and give a breath every 6 seconds, don't need to stop compression's to give breaths if pt has advanced airway/ET tube.

What does the EKG tech do during a code?

This is an ancillary role, the RN can also get the EKG.

Post return of spontaneous circulation (ROSC) . We treat the? We optimize? And maintain?

Treat the cause of arrest. Optimize oxygenation and hemodynamic stability. Maintain sats >94%, MAP 65 or SBP 90

The RN should call the RRT if a pregnant women comes into the hospital with an unplanned what?

Unplanned spontaneous fetal delivery.

With shock energy for defibrillation, what should the joules [J] be for Biphasic?

Use the manufacturer recommendations [could be 120-200j] if unknown, use maximum available. Second and subsequent doses should be equivalent, and higher doses maybe considered.

With CPR and an advanced airway [endotrachial intubation or supraglottic advanced airway] what do we do to confirm placement? How do we do CPR?

Waveform capnography or capnometry to confirm and monitor ET tube placement. Once advanced airway is in place, give 1 breath every 6 seconds [10 breathes per minute] with continuous chest compressions.

When does RRT get called? To prevent what?

When patient is in distress. To prevent : -further deterioration -adverse outcomes -a code blue -death

Should the RN call the RRT if the patient had a seizure, but wasn't diagnosed with a seizure condition?

Yes

What does the Chaplin do during a code?

can communicate with family after the code or if they are there during a code, he can explain what is going on. There for staff emotionally after [Code lavender-a code staff can call when they are feeling over stressed by traumatic events].

What does the pharmacist do during a code?

can manage crash cart, drawing up meds [cannot admin meds], can also tell us if the meds are compatible.

Research suggests that after implementing a Rapid Response System, hospitals experience a decrease in the number of? 5

cardiac arrests. deaths from cardiac arrest. number of days in ICU post cardiac arrest. number of days in the hospital after an arrest. inpatient deaths.

The RRT RN and MD do what during a rapid response call?

co-lead the RRT team and have developed a sense of trust among each other.

A rapid response can turn into a________________.

code, but a code cannot turn into a rapid response.

What are the responsibilities of the RRT RN?

developing a plan of action with the bedside nurse, Respiratory therapist and physician [MD, PA, NP].

What should we know about our limitations?

do not practice new skills during a code blue; if you don't know how to do something ask for help.

More points to remember about debriefing are?

give constructive criticism, not personal attacks or comments. give assertive communication, don't beat around the bush. what can we take forward from this experience to improve upon. be considerate to how it effects the team.

What does a public safety officer do during a code?

helps with flow of traffic, stop people from stopping and watching, can also be available for family members, handle security concerns.

Code team rules for the Code team leader.

keeps the group organized. monitor's team performance. emulates proper team behavior. works as a trainer and coach. focuses on patient care. They are calm, clear, direct and should be positioned where they can see all aspects of the care being provided.

What are constructive interventions?

tactful correction, avoid confrontation; providing feedback in a constructive manner.

RRT team consists of?

•Registered Nurse: an ICU trained RN. •Respiratory Therapist. •Physician: PA, NP, MD.