I currently work on a 10-bed labor and delivery unit at a relatively low risk hospital. On most days it is the happiest place in the building. I feel fortunate to be able to say that we don’t have patients crash often. However, unlike other departments such as the ICU, for example, here the patient population is generally more unstable, we are less experienced in routinely running codes. Last week I participated in my first code.

Because this was not my patient, I had the opportunity to watch the code unravel and learn from it. In the heat of the moment, it can be hard to recall your resuscitation knowledge and skills, but when a patient’s life is on the line, every second counts. Here is what I gathered from my experience:

• Preparing for the worst and knowing your facility’s system in place for immediate response when your patient is deteriorating will allow for quick initiation of life saving measures and notification of the appropriate personnel. Early intervention is vital! (ie. pediatrician, PICU nurses, respiratory therapy, pharmacist, etc.) Learn:
• How to call a code overhead
• Where your emergency crash cart is located and familiarize yourself with its equipment
• ACLS/PALS/NRP algorithms and dosages, or where you have access to them
• Pathophysiology of H’s and T’s
• Initially establishing roles will keep a code organized and running smoother so that everyone involved has a specific responsibility to fulfill (ie. team leader, recorder, compressions, respirations, IV access/medications, defibrillator, runner, etc.) Any other unnecessary traffic should be controlled to maintain as much order as possible
• Clear and concise communications is key. Closing the loop is especially important in giving/receiving orders within a code- by narrating the action as it is being carried out, everyone is made aware that it has been accounted for. The recorder can then note this with the appropriate time
• Debriefing following the conclusion of a code provides an opportunity for an open, nonjudgmental discussion of what worked well and what could have been done differently to improve the efficiency and outcomes of future codes
• Engaging in mock codes regularly offers refreshing of CPR skills, rhythm recognition, and respiratory airway management. This hands on practice helps in getting comfortable with thinking critically and working under pressure within a team
• Being mindful of family in the room is important, but often forgotten. Outside conversation should be left at the door as the only focus of the resuscitation effort should be the patient’s life at stake in this crucial time

Codes can be intense and terrifying scenarios for a new nurse. Though we are never ready to dive into a code per say, being informed and staying grounded are the best ways to approach them and make these situations a little less scary. I hope that this reflection helps you to digest your own experiences with codes and to perform at your very best in your own practice the next time you find yourself with a patient who needs help stat.


Lia is an RN, BSN, PHN who works as a Labor & Delivery RN. She resides in Texas.

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