Advanced directives and DNR orders are legal documents that indicate whether a Pt wishes to be resuscitated (and to what extent) in the event of respiratory or cardiac arrest. If any doubt exists about the interpretation or whereabouts of a Pt's advanced directives, then a code must be called and resuscitative efforts initiated.
- Pt who is unresponsive with no detectible respirations or pulse.
- Pt in respiratory arrest (or pre-arrest).
- Pt who has become critically unstable hemodynamically.
- Stay calm! Call out for STAT help or press bedside code button if available.
Note: Always include floor, unit, and room number. - Clear immediate Pt area of any obstacles (e.g., tables, chairs).
- Instruct visitors to wait outside the room.
- Begin resuscitation (CPR) while waiting for code team.
- Assist code team resuscitation efforts including compressions, ventilations, medications, defibrillation, or documentation.
- Notify physician or physician on-call and request chaplain to notify and communicate with Pt's family.
- All code team members must sign code record.
- Record all times and interventions, and attach ECG strips to code record in chronological order. Clinical tip: Record times and interventions (e.g., drugs, shocks) directly onto ECG strips for easier recall after the code.
- Document a brief summary with outcome in Pt's chart.
- Attach code record to Pt's chart after completed.
- Prepare Pt for transfer to ICU.
- Write a transfer note and give report to receiving unit.
- Leave all tubes in place and check with your supervisor to determine what can be removed. If an autopsy will be performed, you will not remove anything.
- Clean and cover the Pt and straighten the room before the family views the body. If family members were present at the time the Pt coded, sensitively ask them if they would like you to do this first. It may be unbearable for them to wait. ALWAYS consider the family's needs first.