Taking Codes from Chaotic to Calm

As a health care worker, one of the most stressful situations you can ever face is a code blue. Whether your own patient is coding or you are called to a code somewhere else in your facility, the fact that a patient’s life is in your hands is a weighty realization. No matter how many hours of experience or years of education you have, hearing a code blue called or reaching for the phone to call one yourself is sure to get your heart pumping and adrenaline racing through your body.

Despite your nerves, you need to stay calm in the face of this crisis in order to respond well during the code, imbue your coworkers with calm and accurately read the symptoms the patient is displaying. Whether you are a new graduate who is worried about facing your first code blue or an experienced unit supervisor who needs tips on how to keep those around you calm, read on for some suggestions on how to take your next code from chaotic to calm.

It can be easy to doubt yourself when it comes to a critical situation. Especially if you are a new graduate, you may not realize that you have what it takes to respond well to a code blue. However, the fact that you are working as a licensed health care provider should tell you that you have the knowledge and skills necessary to care for your patient extremely well.

In addition, pay attention to those little signs and symptoms that your patient displays throughout the shift that could be trying to get your attention to show you that something is wrong. Instead of doubting yourself, trust your gut, and notify a doctor or someone else who can help.

This may seem like a silly tip, but the difference between grabbing the crash cart immediately or running through the halls trying to find it for even two minutes can mean the difference between life and death. The defibrillator should be one of your best friends during a code. If you are working as the charge nurse on a unit, you should also check the crash cart for adequate supplies and ensure that the defibrillator is working at the start of any shift.

Unless you are working as a home health nurse, you should nearly always have plenty of backup when your patient begins spiraling downward. As a new nurse or other type of health care provider, you may initially feel nervous or embarrassed of asking for help and may fear that your coworkers will think less of you for not knowing all the answers.

However, realize that each practitioner has a different knowledge and skills set. You may know some things that your coworker does not yet know, and your coworker may have experience with a certain type of patient with whom you have never yet worked. Call for help immediately using the nearest code blue button if available.

The basic life support class that you took back when you wanted to get a higher-paying babysitting job is just as important to know now. Even though you are now a trained health care professional, the most important skill to rely on when dealing with a patient who is coding is CPR. Defibrillators are certainly the best option for certain heart rhythms, but chest compressions and assisted respirations still cannot be beat for a myriad of other rhythms or for when a defibrillator is not readily available. Plus, basic chest compressions are used between shocks as well as while medications are being given.

On a different note, be aware that the CPR skills you learned as a teenager have changed since then. The American Heart Association regularly makes changes to its recommendations for chest compression rates and assisted breathing. Take a new BLS class every two years to stay up-to-date.

Practice makes perfect, and this is especially true when it comes to emergency situations. Most likely, you are not dealing with a code every day unless you are on a very specific unit. However, on those rare circumstances when your patient does code, you want to be able to respond quickly and accurately. Working through a variety of scenarios with your coworkers can help all of you learn to work as a team and brush up on skills before you are face-to-face with a patient who is coding.

Another great place to practice your skills is in a certification class. BLS, ACLS and PALS classes all give you plenty of practice sessions and also test your skills during a mock code.

Although some codes happen out of the blue, many patients display certain signs or symptoms before they code. By recognizing these signs, you may actually be able to prevent certain emergencies.

Some of the most important early warning signs of deteriorating health in your patients could include slowed respirations, decreased heart rate, low blood pressure, a change in level of consciousness and slowed urinary output. In addition, your patient may give an audible warning, such as by saying that something just does not feel right. Recognizing the deteriorating condition of your patient will give you more time in which to act and will help you remain calm.

Nowhere is teamwork more important than in the business of saving lives. In a hospital or busy clinic, you should have all types of professionals on your code team. This will give you the benefit of all knowledge levels and advanced skills sets. It will also ensure that there is someone to fill every necessary task during the code. Your code team should include doctors, nurses, respiratory therapists, social workers, chaplains, nurse aides, pharmacists and possibly others depending on the size of your facility. While some have hands-on roles, others help family members get through this tough situation. When you do not have to do every task yourself, you can focus more on doing your one task well.

One of the most important components of great teamwork is excellent communication. During a code, you must speak clearly and confidently. You must also speak loud enough to ensure that everyone else in the room can hear you but not so loud that you raise the stress level in the room. Be sure to ask questions when necessary and respond out loud when you complete a specific task, such as giving a medication or searching for a pulse. Good communication helps all health care workers in the room find the correct job and stay task-oriented.

Clearly, knowledge and skills are two of the most important considerations when it comes to the success of a code and also when it comes to your confidence level. If you have limited knowledge of caring for patients in physical distress, you are going to feel anxious and stressed during a code. However, simple continuing education classes can help you improve your knowledge while also giving you the ability to respond to a code with advanced techniques.

Three of the most important certifications to consider depending on the age of the patients with whom you typically work include the following:

-ACLS, which is for adult patients and is particularly important if you are a house supervisor, adult care provider or a health care worker in a critical care or emergency unit
-PALS, which is for pediatric patients and is vital if you are an advanced care practitioner on a pediatric unit or pediatric intensive care unit
-NRP, which is for infants and is important for practitioners in neonatal intensive care units

While a code should never feel completely chaotic, this does not mean that you are going to feel perfectly calm and undisturbed. That rush of adrenaline is necessary to help you move and think quickly, but it could also give you an increased heartbeat and respirations.

Believe it or not, there is only a 20 percent chance that your patient who suffers an in-hospital code will survive and actually be discharged. Although this may seem like a dismal number, you can do your part in ensuring the best success rates in your facility by being a leader on your floor, reacting calmly to any codes that are called and responding quickly whether it is your own patient or a coworker’s patient whose life is at stake.

Even thought your heart is sure to start pumping faster and all of your senses will be on high alert, you can still maintain a sense of calm around you. Be confident in what you already know, never be afraid to ask other professionals for help and get the extra education and certifications you need to improve your knowledge and skills.