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Who• Physicians from
Anesthesia Medicine (on call MICU and cardiology teams) Surgery
• Nursing House supervisor ACLS trained nurse from CCU/CTICU ED nurse for specific areas
All neuroscience floors except 6NSH All diagnostic areas (Radiology, labs, Clinics) All non-patient care areas
• Pharmacy• Respiratory therapy• Pastoral care• Patient transportation (responds if in a non-patient care
area)
Where• All codes within UNC Hospitals • Within the following external boundaries:
Base of Cardinal, Dogwood and Neurosciences parking deck ramps
ED parking area visible from doorway of ED
Once you get there:• Physician team leader must identify self• ACLS trained nurse from CCU/CTICU provides nursing
support ICU nurse must remain with the patient until the patient is
transferred to the appropriate level of care• Primary nurse remains present for the duration of the
code• Pharmacist assists with medication preparation • Respiratory therapy provides respiratory support• Nursing supervisor
Provides assistance with crowd control Facilitates patient transfer to appropriate level of care
All team members should identify themselves and their roles upon arrival
A resuscitation record must be kept by a documentation nurse
The physician team leader signs the record and completes a summary section
Background• 80% of codes are preceded by a prolonged
period of physiologic instability• Introduced at UNC in 2006• Purpose:
To quickly and appropriately respond to inpatients with early signs of physiologic deterioration, and thus:
Decrease the number of Code Blues Ideally improve survival to hospital discharge
Staff or family have concerns Acute change in HR Acute change in systolic BP Acute change in respiratory rate Acute change in oxygen saturation Acute change in urine output Acute mental status change New or prolonged seizure Patient with difficult to control pain or
agitation
Activation of RRT by calling 6-4111 Page primary resident
Who depends on location• Medicine floors:
3W/HD, 3BT (CRU), MPCU, 4 ADU, 6BT, 6W, 7BT, 8BT, 3,4,5 Neuro; 4 BM and 4 ONC, 5 And South (Jail)
NOT cafeteria, radiology, GI suite – Call a code MICU nurse MICU fellow (when in-house) Hospitalist on call (after 7 pm) MICU resident (recommended)
• Cardiology floors: CCU nurse Cardiology team (Resident)
• Surgery floors: SICU team and nurse
• Primary team physician (or cross-cover) must show up as well
Physician team leader identifies self and coordinates assessment and care with the primary physician
RRT nurse from ICU provides nursing support and coordinate with primary nurse
Respiratory therapy assists with maintenance of airway and ventilation
Documentation of Adult Rapid Response Activation must be completed by the responding care providers
Debriefing following the event with the RRT and primary care team (including nurse!) should take place
Introduced March 2010 Purpose:
• To provide inpatients with acute stroke the same care they would obtain if they presented to the ED: Rapid head imaging Rapid evaluation by neurology Early administration of fibrinolytic therapy if
indicated
Composition• Neurology resident• Neurology/neurosurgery ICU nurse• Patient transport
If rapid response team or code blue team is worried about a primary CNS event, the team calls the hospital operator to activate the brain attack team
Med E Resident on call is first responder to all codes/RRT in the Cancer Hospital• This includes clinics!
In the aftermath, have a lower threshold to move patient to stepdown level of care
Med E patient (and Solid Med H?) in MPCU managed by MICU team• Do not let this dissuade you from moving
patient to stepdown level of care!!!
3 West 6 BT 4 OncRRT/1000 discharges
24.8 35 40.9
Code Blue/1000 discharges
2.8 3.6 9.1
It’s a land far, far away It gets lonely out there
• Med E resident in ED, covering patients elsewhere
• Only on floor 30-40 percent of the time at night Ryan, fix this please
Teams are reluctant to transfer patients to stepdown
This is based primarily on nursing competency, not resident competency
If the floor nurses say they cannot manage the patient, then they must go to stepdown
If the floor nurses say they cannot manage the patient, then they must go to stepdown
Nursing competencies vary by floor
Blocking and Belittling the referring physician or nurse
“There are no ICU beds”• RRT nurse stays to help manage the patient• You work with House Supervisor to find or
make a bed• Call in the MICU fellow to lend a hand if your
team is overrun Call Dr. Carson if you get any push-back