Using the EPIC Code Narrator
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
Lines, Airways, & Quick Notes
LDA's & Etc.
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)
Resuscitation Interventions
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
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
- 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