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Raising the Bar in Rehab

Code 4

Published September 24, 2009 2:47 PM by

Several weeks ago I was at our daily OFT (Outcome Facilitation Team) meeting when we heard over the speaker system, "Code 4. 5th floor. Room 12."  A Spanish-speaking patient had passed out and became unresponsive, and a code was called for the Stat team to her room for resuscitation.  As the nurse would later describe, she was attempting to fix the patient's IV as the patient sat at the edge of the bed.  The patient said a few words (in Spanish), and proceeded to fall backward onto the bed.

It was like a scene out of a TV show. 

There were probably 30 people crammed into this small hospital room, so I stood at the doorframe and just watched to see what was happening.  I had never witnessed such teamwork, such decisiveness like that.    MDs and pharmacists were working together, RNs watching the EKG for any heart function, lab technicians were taking draws for blood gases, respiratory was providing rescue breaths while another health care provider continued with CPR.  Every few minutes the whole room would go silent, someone would start the AED, and then an MD would yell "Resume CPR", and the room would return to it's level of cooperation.  Every once in a while someone would yell out for a piece of equipment, or to watch for family members to arrive. 

I really had no medical purpose to be near the room. But, I was so drawn to watch it and couldn't pull myself away.  I hadn't ever imagined being involved in, or even seeing, something so heart wrenching.   Many times in the hospital we put up barriers in our jobs, saying things like "That's a job for a nursing assistant, not me".  Or, if a doctor interrupts our treatment session, many therapists will walk away and re-attempt the patient at a later time.  We divide our territory into segmented pieces, many times for good reason.  However, in situations to revive an unresponsive patient, we work together as a seamless machine.  Titles no longer make a difference.  Every person plays a vital role. 

I saw a Hispanic-looking woman step off of the elevator and burst into tears, and knew immediately it was the patient's daughter.  One of the MDs and the chaplain took the daughter into the family lounge to discuss the chain of events and options available.  The patient eventually went into V-tach and was transferred to the Neuro ICU. 

For the sake of completion, I will tell you the patient did not make it.  And even more unfortunately, no one understood her last words. 



Now here's the thing to take from that experience: If we didn't draw these boundaries and all worked together on a regular basis, maybe our outcomes would be better as well and maybe that lady wouldn't have passed.

Dean Metz September 25, 2009 12:40 PM

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