First Code

so I had to code my first patient last night. Sort of unexpected as he was an RRT earlier in the day for chest pain but the EKG was clear as was the lab work. He was cleared to stay on our floor as we are a non tele floor so he wasn't continuously monitored. When I came on at 2300 he was pale as a sheet and they had put in a foley as he hadn't voided in 26 hours (according to him). So I made rounds at 0140 and saw the blanket rising and falling. at 0240 the aide went to do vitals and found him unresponsive. I won't go into the details but if I never have to feel myself crunching ribs it will not be a long enough time!

Anyway I got a call from my manager today asking me about the events of the night as they're doing a mortality review. Is this standard? It gives me an even sicker feeling in the pit of my stomach - I know I didn't do anything "wrong" per se - but now I'm worried about my job security!
Sometimes this just happens. I've also felt the crunching of ribs when doing compressions. If you do it often enough and it will become part of the normal course of things and it won't bother you so much. Yes, it's completely normal to feel unsettled about it after your first code. Now I'm not a lawyer nor do I have any particular insight into some things, but I would imagine that they're simply doing their own due diligence with this death investigation so that they can be sure that everything was done according to policy. I would imagine that the code was run the way it should have, so they're probably going to wonder about the chain of events that led your patient to be on your floor, not on monitor.I know this: You'll remember your first code, and after a while, you'll remember your most recent one and the rest will blur unless something sticks out. Hopefully you won't have that many that the blurring takes place.

I'm not sure how standard a mortality review is, but it sounds like you did just fine. His symptoms were being addressed, you were doing your hourly rounds, and you initiated the code when he was found unresponsive. If every nurse's job security was in danger every time s/he was on the clock when a pt arrested, a great many of us would be in trouble! Hugs!!

It's normal to feel that way after a code, especially under those kind of circumstances. I would be more worried if you didn't feel like that! It sounds like to me you didn't do anything wrong. Other than being pale, it doesn't sound like he was showing any kind of symptoms that would've warranted some kind of immediate intervention at the time. Without any telemetry, there's not much you could've done to prevent it, that's why when there's any suspicion of a cardiac issue, they should at least be on a tele floor for observation. Often times an EKG will be normal during the initial stage of an MI, if that was the problem. They should've at least done 2 more sets of enzymes and either repeated the EKG or put him on tele to fully r/o a cardiac event. Bottom line, you responded appropriately to the situation, so just stick with the facts and everything will be ok. You have no control over what happened before you got there, sounds like you sort of just walked into a mess that wasn't handled appropriately.

All codes are usually reviewed. It is for QI purposes.It's ok to feel this way codes are not easy....((HUGS))

Normal for it to be reviewed. I know a code in my hospital that happened last year was reviewed but the nurse was not found of doing anything wrong. Sounds like you took all the appropriate actions. I agree another two sets of cardiac enzymes should have been done, as well as placing the pt in a monitored unit.

They review all codes at my facility, too. Based on you post, it sounds like you did what needed to be done. I remember my first code, too, and that was 8 years ago.