In this episode I’ll discuss 6 tips for pharmacists responding to inpatient medical emergencies.
After years of working in the central pharmacy, an opportunity arose to go to the floors for code blue and rapid response calls. At the time, I was very nervous!
Nothing in my pharmacy training or career prepared me for responding to medical emergencies. I was concerned that I wouldn’t have a role on the response team – they had gotten by for a long time without a pharmacist, what could they possibly need one for? I was wondering what heroic or fantastic thing I would have to do to fit in or prove my worth to the team.
It turns out – it wasn’t nearly as challenging as I thought it would be! Now after years of responding to medical emergencies I can share these 6 tips:
1. Just be a pharmacist
I realized that when I did simple “pharmacist” things, that is when the patient and the team benefitted from me the most. It turns out just doing the same things I did when I was in the central pharmacy was more than enough to help everyone out.
It might seem to you that you are not doing anything special. Just because it is easy or second nature for you to do, doesn’t mean that it isn’t valuable to your patient or team.
2. Label medications
Properly labeled syringes and IV lines will help prevent medication errors in the fast-paced scenarios of code blues and rapid responses. You’ll need to prepare labels ahead of time so you don’t slow down the administration of critical medications.
Keeping preprinted labels in your drug boxes is very helpful. I also keep a roll of medical tape in my lab coat so that I can use that to label syringes and IV lines. In a pinch, I can always tape the syringe and medication vial together.
As the IV drips start to pile up, it can be very confusing and time consuming for the nurse to sort them out. By labeling the IV lines, you can facilitate the nurse getting the right drugs to the patient and working around IV incompatibilities. I place a label near the port closest to the patient and another label on the section of tubing that is above the smart pump.
Be sure to include the drug name, the date, and time the IV infusion was hung on the label so the nurse can change the tubing at the appropriate time.
3. Provide medications in the most ready to administer form
For IV infusions, this means to prime IV tubing (have a nurse show you) and label the lines.
For IV push medications, give the nurse a primed saline flush and an alcohol swab along with a labeled syringe of the medications.
4. Grease the wheels with your department
Sometimes the team will need some unconventional therapies to help the patient (think IV push tPA or methylene blue). You’ll know just who to call in the central pharmacy and what to say to get the ball rolling and the medication dispensed in a timely manner.
5. Learn about the non-pharmacy tools of the trade
Take some time outside of an emergency scenario to learn about the non-pharmacy “tools of the trade”. If your hospital has a clinical nurse educator, seek them out. They probably have access to a training version of a code cart and would be happy to go over it with you.
When I’m not doing something with medications at an emergency, I can still assist by being an extra pair of hands. Take the time to learn things like:
– What does an end tidal CO2 detector look like?
– What drawer is an IV start kit kept in?
– Where is the on switch for the defibrillator?
6. Expect some false alarms
Housekeeping might accidentally hit the code button, a patient may have fainted and be alert and talkative by the time the code team arrives, or a floor nurse might call a rapid response on a patient that doesn’t seem to have anything wrong.
Whatever the cause, it is important to never speak negatively about a ‘false alarm’ code or rapid. If others overhear such talk, they may be hesitant to make the call for help in the future when they actually need it out of shame or embarrassment.
Think of the model that the cardiac cath lab employs to be on call 24/7 for STEMI patients. The cath lab team knows that once in awhile, the EKG will have been misread and when they are called in at 3am the patient won’t need to go to the cath lab. Rather than shaming the ED or EMS team for not getting the call right, they smile and turn around – knowing that if they do anything negative, the same doc might be hesitant to call the team in again.
Bonus
You can download a pdf of the 6 tips for code blue response discussed in this episode in my free critical care pharmacy download area:
Teaching pharmacists how to respond to code blue calls is a passion of mine. It’s why I created the Critical Care Pharmacy Academy.
In the Academy, I provide more in-depth training and support for pharmacists that wish to learn how to respond to code blue and rapid response calls with my “Learn Code Response Blueprint.”
The Learn Code Response Blueprint is a series of Masterclass video trainings that teach Code Response Basics, Airway Pharmacology, Septic Shock Management, Patient Assessment, and ECG Recognition for Pharmacists.
I also personally provide support for all Academy members in the private forums by answering their questions on code response and critical care pharmacy topics.
Academy members get access to the menu-based Help! My Patient Has… quick reference app and much more!
Click here to learn more about the Academy and how it can help you respond confidently to code blue and rapid response calls.
My book also serves as a pocket reference guide for pharmacists who respond to codes – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.