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Using the EPIC Code Narrator

Date 1

LLUMC Murrieta NICU

Presented by: Sarah Ledesma MSN-Ed, BSN

Background

EPIC

  • LLUMC uses EPIC for its daily operations, allowing for seamless communication and data collection between multidiscplinary teams, inpatient and outpatient service centers, as well as ancillary support systems.

  • Utilization of Electronic Health Record (EHR) during Code Blue event is considered the standard of practice.

  • Code RN documentation is essential in meeting guidelines set forth by the American Heart Association (AHA).

Real Time Charting for the Code Nurse

Why real time

charting?

  • Code Narrator program takes the place of the traditional scribe in the code situation.

Tracks Important Tasks:

  • Medications
  • Airway
  • Compression
  • Cardiac Rhythms
  • IV medications
  • Line insertion
  • (Peripheral & Central catheters)
  • Team Member Arrival

Real time charting benefits:

Transcribes

DIRECTLY

into patient's chart.

  • Minute by minute account of what occured during resuscitation.

  • Easy access to commonly used medications accessible via department specific tabs.

  • Limits the loss of information from using notes on papers and transcribing into charting.

  • Helpful in outcome tracking

Multidisciplinary Team

Able to Document/ View Documentation

Who is Involved?

  • NICU RN's
  • Neonatologist
  • Respiratory Therapists
  • Pharmacy
  • Lab
  • Radiology
  • Administration doing Code White Review and Auditing
  • Secondary/Higher Level of Care Facilities

Starting the Code

Examples

Lines, Airways, & Quick Notes

LDA's & Etc.

Emergency Medications

Medication

When do we call a CODE WHITE ?

Code White

DIAL 62222

How to call a CODE WHITE

Code Team

Who comes to help??

  • ER MD/ Neonatologist
  • House Supervisor
  • Additional Respiratory Support
  • Pharmacy
  • Additional RN's/ Charge RN
  • SW/ Clergy (during day shift)

Medication Review

Resuscitation Interventions

Epinephrine

The suggested initial IV or IO dose = 0.02 mg/kg

(equal to 0.2 mL/kg)

The suggested endotracheal dose (while establishing vascular access) =

0.1 mg/kg

(equal to 1 mL/kg)

NRP 8th Ed.

Case Scenarios

33 wk, no IV/UV access, Intubated. weight: 2 kg

41 wk, UV access, Intubated, weight: 5 kg

Practice

35 wk, IV/UV access, Not successfully intubated due difficulties.

weight: 2.5 kg

1. 2ml (ET adminstration)

2. 1 ml (IV/UV administration)

3. 0.5ml (IV/UV administration)

Answers

Other Interventions

Code Narrator Check List NICU

Double check the Code Narrator and make sure it accurately reflects events during the code, as follows:

Code Narrator Check List NICU

Code start time documented

Code Start

  • Start compressions within ONE minute of HR < 60

  • Pulse Checks Q 1 minutes- chart under interventions.

  • Document ECG leads on & rhythm noted

Airway Management

Airway

  • Airway (assisted) and what type (bag-valve-mask or via Endotracheal tube) (with pulse check)

  • MR . SOPA steps taken & successful (suction catheter size/ attempts)

  • Time of intubation documented, by whom, # of attempts.

  • Intubation confirmation documented:
  • CO2 detector color change & pH #
  • Measurement
  • XRay

  • SPO2 documented with pulse checks

Medications

  • Ensure all Medication given during code is documented within Navigator:

  • Order automatically triggered through the narrator
  • Ordering MD identified
  • Administering RN is identified
  • Route, Dosage, & frequency completed
  • May adjust 'Administration time" after the fact if necessary.
  • Epi to be given Q 3-5 minutes, always document HR check before Epi administration.

Medication Management

Wrapping Up

  • End code time documented
  • Reason for stopping resuscitation effort documented
  • All responders in the room listed and documented when they
  • Arrived
  • Departed

Outcome

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