Pharmacist - a member of a cardiac arrest team

You mean code team? Every regular RPh at my hospital responds to codes...by "regular" i mean normal clinical/staff pharmacist working on the floors or in order entry, as opposed to say, the IV room pharmacists or admin and whatnot. We don't really have teams per se...its more like if there's a code on a neuro floor, the pharmacists that cover that floor will go. It starts becoming a free-for-all when codes are called in weird areas, like rads, public areas, etc.

Hell, even I've been to codes. Not that I do anything productive or remotely life-saving (yet)...its pretty analogous to an MS3 tagging along with an attending. Maybe they'll let me make a neo or levo gtt one of these days.

I was going to say all hospitals do this, but coincidentally, while I was at a pseudo-code, I was talking to an RN on call. She thought I was a dashing young resident until I told her I was pharmacy...anyways, she was complaining about how the small community hospital she works at has "good for nothing pharmacists" who don't respond to codes. So I guess it depends on how big the hospital is and how well it's staffed, cuz i'm pretty sure that hospital has limited pharmacy services.

As far as what you would do, my impression is:
-"run" the code cart...but some RNs are really really possessive of it. We have everything drug related (epi, atropine, amiodarone, d50, bicarb, lido and so on...) as well as a buttload of respiratory stuff (laryngoscope, ET tubes, ambu bags), IV drips, flushes, gloves, central line kits, chest tubes, angiocaths...and the kitchen sink.
-draw up/make any meds needed. Mostly, this involves assembling the epi/atropine abbojects. Occasionally they'll make stuff...the ones I see the most are usually IV metoprolol syringes and phenylephrine drips...followed by the high K thing (i think CaCl2/bicarb/D50/IV insulin), and thrombolytics like tPa.
-Now that I think about it, getting weird meds too...say dreamy anesthesia resident runs out of propofol and it's not an ICU. Guess who's running to the nearest ICU for some milky white anesthetic emulsion? Definitely not the ACLS expert who happens to be an MD...
-filling out paperwork, although RNs do it too...like what/when/how much drugs were administered, making sure they aren't maxed out on atropine...etc.

Other than that, the anesthesia service and whatever residents and nurses who are around will be doing most of the work. ACLS is pretty standardized in that you follow the algorithm and rarely deviate from the pathways, meaning that the residents will tell you what they want and you give it to them as fast as possible. Sure, nursing could draw the meds too, but my head starts hurting when they start trying to jam blunt cannulas into vials...but that's another thread altogether.

 

Well, we have designated people who go and don't go (or else everyone would go), but it's not really a big deal, no one is like "oh boy you're assigned to code team you're saving lives". It's more like "oh crap code blue he's on one of my floors i gotta go help." It's just one more additional responsibility like entering orders or reconciling meds. I can't really imagine a real hospital (over 100 beds) where pharmacy doesn't respond to codes...unless you really really dislike nursing or something.

BTW, the minimum team at my hospital usually consists of the senior of whatever service the pt is on, whatever residents/interns are taking care of the pt, anesthesia, the dreaded nursing supervisors for the floor, at least 1 person from respiratory, and pharmacy. And believe me, the nursing supervisors do a good job at yelling at everyone not needed to GTFO.

 

i have been to codes as a student...in both hospitals where i work, pharmacists don't go to codes. either we are too understaffed,or nursing feels that we won't be useful. i'm not sure which, probably both.
i would enjoy being a part of the code team...CPR is exhausting, and anyone ACLS certified should be put to good use helping...

 

During my year of rotations, I've seen it both ways. Some hospitals have pharmacists on the code team and some do not.

 

Floor pharmacist responds to codes in my insitution. After the floor pharmacy is closed, the main pharmacist goes.

 

Why would a pharmacist "run" the code cart with all the stuff besides the drugs? I dont recall any pharmDs inserting central lines or intubating people.

i've seen pharms at codes before. They pretty much stay out of the way, mix up the drugs and give it to the residents/nurses to inject.

They certainly dont run the ACLS protocol or bark out any orders, or actually touch the patient for that matter.

 

I would say half of the pharmacists on our clinical "team" are ACLS certified. my mom is an ICU nurse so I have her CD Rom from the last time she did it and I'm learning my arrhythmias when I want to procrastinate other things.

It's absolutely useful to be able to look at the situation and know what the person running the code is going to ask for next. I wouldn't say we have a specific team that does only codes but one pharmacist at all times is carrying the "Dr Heart" pager and drops everything to go.

 

You're absolutely right. We do try to stay out of the way & our terminology of "run" is different from yours as a physician.....comes with the territory of skimming different threads I think.

Our concept of "running" is to be sure the documentation is accurate, all drugs are available as needed (the code cart sometimes does run out or one is called for that is not on it - we have fast & direct lines to those who will obtain it quickly), in the form they are needed & to be sure the cart is replaced promtly. It doesn't seem to matter which unit a code requiring the cart occurs - there are often enough times that another situtation arises that the cart is required again. I'm old enough to remember the times when the cart wouldn't be replaced for hours by nursing & they'd be left short of something. Likewise...I can also remember too few nurses who responded & no one realized until later there was no one documenting. In those hospitals who have pharmacists on code teams - they are the ones who must document. In hospitals in which there is none - all these tasks fall upon nursing.

But - as to your specifics - I will agree with you wholeheartedly - we do not bark out orders (altho - the physicians I work with don't really bark!), intubate, insert lines or otherwise manipulate the patient at all.

I don't really think we were trying to mislead the OP or you - it is a difference in terminology & I'm aware it is used only within our own profession in the way it has been used here. It is important for those pharmacy students reading to realize this - the phrase "running" a code is viewed very differently by physicians & nurses. This will avoid similar situations in which the actual practice of medicine or nursing appears to be invaded by those who do not have those skills.

So....altho we all understood our terminology, I can see where you perhaps didn't. No offense intended & we hope none taken?????

 

Where I'm at a rotation right now, the pharmacist is in the ER right in the thick of the action getting atropine and norepi ready standing right next to the attending.