respiratory arrest or recycling the BP because no blood pressure was registered. Utilizing assessment data from multiple sources can prevent this error. For example, in this situation, a clinician should be assessing the respiratory rate and effort as well as using the cardiac/respiratory monitoring systems. All three of the fixation errors can cause delays in treatment and increased mortality and morbidity. Using team members for alternate solutions is one strategy in preventing or identifying fixation errors early. Another strategy is to conduct team training that includes examples of these errors in a simulated event and to have the team members practice the communication techniques of closed-loop, state of the response, and stop the line.
Evidence-based practice! Fixation errors are something that crisis responders want to avoid. A fixation error is failure to change course of action without considering any new information (Fioratou et al., 2010). There are three main types of fixation errors: The and only this; Everything but this, and Everything is OK (Ortega, 2019). Self-Assessment Quiz Question #10 The fixation error of not being able to see any other possible solution to a situation is known as:
1. This and only this. 2. Everything but this. 3. Everything is OK. 4. Where Do I Stand?
SPECIALTY TEAM MEMBER ROLES
Nursing There are multiple roles for nursing in a crisis. The role will depend on the situation, whether it is medical in nature or a response to an environmental issue. The roles in a medical response will be related to a nurse’s professional scope of practice as designated by the Board of Registration in the state of practice. Nurses who practice at advanced levels, such as nurse practitioners, may function at the higher level as a licensed independent practitioner. Typical roles for the staff nurse in a hospital-based cardiac arrest response include the bedside nurse, medication nurse, scribe, and circulator. Nurses in outpatient facilities, school nurses, prison nurses, or nurses in extended-care facilities may be expected to carry out extended CPR and disaster management roles according to established protocols. However, limited resources in these environments do not allow nurses to function beyond their legal scope of practice. The patient’s nurse should always stay in the room with the patient. This nurse knows the patient’s history, most recent baseline state before any change in status, and may also have a relationship with the patient and family and can offer the additional relevant information as a result. For example, in response to a suspected active acute stroke, the bedside nurse will likely know the last well time, what medications the patient is on, and when they last had something to eat or drink. This can also apply to the outpatient setting, where the staff member or family member who is most familiar with the person having an emergency remains at their side to detail the events leading up to the situation. Medication administration is one major nursing role during a crisis. Medication administration is within the scope of practice for nurses under LIP orders. Nurses in this role must practice closed-loop communication and verbally read back to verify the order given and understand the typical medications they are administering. Nurses in outpatient settings will need to know common situations that may occur in their setting and what the institution has on hand to assist the patient. For example, in an outpatient day surgery setting, the nurses would be trained for anesthesia-related emergencies or post-operative recovery situations. They would be familiar with narcotic reversal medications and medicines used for airway situations under the direction of the anesthesiologist. All nurses who work in inpatient or outpatient areas where medications are administered should also be aware of the treatment for severe allergic reactions, common medications used for them, dosing, and administration methods. As administrators of medication, nurses should be aware of the resources available for them in this role. Pharmacists are also resources for medication storage, preparation, dosing, Case study #1 Sarah is a nurse working in a subacute care facility. She has been working there for slightly over one year. Today she has a typical patient assignment and has also assumed the charge nurse role of her 25-bed unit. She is working with two other nurses: Jane, an LPN studying for her RN license and Ken, a per diem
and administration. Medication guidelines may be stored with the emergency equipment/go-bag or available links for online resources. Some institutions have internal medication guidelines for their code teams on the crash/code cart. Others rely on commercial resources like the Broselow tape, which lists by color and weight the medication doses and equipment sizes for pediatric patients (DeBoer et al., 2005) or the AHA’s ACLS, PALS, NRP (Neonatal Resuscitation Program) algorithm cards. The scribe documents all the care and data during an emergent situation, including the time of treatments, medications, actions, and other important information, such as vital signs and patient assessments. There is often a scribe during situations such as fire and environmental disasters where patients are evacuated. To accurately account for the safety of all patients, there must be a record of all patients leaving the impacted unit and arriving safely to the planned evacuation unit. The scribe in this situation will also document the departure and arrival of all personnel and visitors. In hospital settings, the nursing leadership will fulfill the role of bed manager. For medical emergencies, they will ensure that the patient is in the unit to provide the correct level of care. For environmental emergencies, they may oversee the relocation of affected patients with respect to the patient’s acuity and staff resources. Decisions for the transfer of patients that are necessary for internal or external disasters are made by nursing management. Immediate rescue of patients may be made by the nurse first responding. Pharmacists and respiratory therapists Another resource that may be available in the hospital setting for code responses is a pharmacist. When a pharmacist is a code team responder, there has been a reduction in medication errors during resuscitation (Bolt et al., 2015; Ferguson et al., 2019). Pharmacists should be comfortable using the emergent drug systems on the code/crash cart and have a familiarity with the preparation of emergency medications. When a pharmacist is part of the stroke response team, their knowledge of the preparation and administration of tPa is useful to the quick response of treatment for the patient. Respiratory Therapists have a specialized role of assisting in maintaining a patent airway partnering with the anesthesiologist. They provide bag-mask ventilation, assist with endotracheal intubation and support. Pharmacists and Respiratory therapists will need to know the standards and regulations of both the institution and state where practicing related to their specific role in responding to an emergency.
RN employee; and three nursing assistants: Dotty, a long-term employee in the nursing assistant role; Jeanne, a new nursing assistant who started less than a month ago; and Helen, a nursing student who works per diem as a nursing assistant. It is the 11 p.m. to 7 a.m. shift on a weekend night. The patients are
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Book Code: ANCCUS2423
EliteLearning.com/Nursing
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