Mayday Procedures

All residents should be familiar with the BMC policy: PC.C.1 - EMERGENCY RESUSCITATION POLICY AND PROCEDURE which can be found within speech docs and is included at the bottom of this document. Medical House officer involvement in the Mayday team is summarizedbelow, but is subject to all content within Policy PC.C.1.

  • The Mayday Team is the multidisciplinary team that responds to all cardiopulmonary arrests within the hospital.
  • Membership: Medical ICU Senior and Intern, Surgical House Officer, ICU Charge Nurse, IV Therapist, Respiratory Therapist, EKG tech, Orderly, Primary Care RN, Crisis RN, & when present in the hospital Intensive Care Attending & Anesthesiologist.
  • The ICU medical team “on call” carries the Mayday Beeper and comprise the medical resident component of the Mayday team.
  • Responsibility of the Medical House Officer in Charge (Senior ICU Resident)*: When a patient on the Surgical Service is resuscitated, a Senior Surgical Resident (PGY 3-5) if present at the Mayday will assume responsibility for directing the resuscitation.
  • Supervises the Mayday “Runs the code.”
  • It is expected that the Senior Medical Resident will work with other members of the team and utilize the considerable expertise and opinions of the entire Mayday team.
  • May delegate responsibility for supervising the Mayday to an Attending Physician or fellow Resident.
  • Delegate the necessary tasks to the Team members.
  • Decide when to cease resuscitative efforts.
  • Communicates or delegates communication with family and attending physician of record any changes in the patient condition.
  • Completes documentation of the “code” in the progress note section of the medical record and signs the nursing documentation.
  • Performs the death certificate and notifies the medical examiner if necessary (or delegates this to the covering floor team).
  • Responsibility of other House Staff:
  • All House Officers assigned to the Mayday Team proceed to the scene.
  • All physicians, medical students and auxiliary personnel not in direct attendance to the patient will be asked to leave the immediate area.
  • Delegation of tasks will come from the physician in charge, the Senior Medical or Surgical Resident.
  • It is expected that the covering medical team (if the patient is covered by a floor team) is present and assists in managing the patient by providing background information and helping to contact the family and attending. At night the night float will assume this role.
  • It is expected that the floor team (or covering night float) will accept delegation from the Mayday Senior of filling out the death certificate and notifying the medical examiner necessary.

* All residents receive ACLS training & certification as part of their orientation prior to starting

POLICY

TITLE:PC.C.1 - EMERGENCY RESUSCITATION POLICY AND PROCEDURE.

PURPOSE:To describe policy and personnel involved in emergency resuscitation procedures.

APPLICABILITY:Medical Staff, House Staff, Nursing Service, Anesthesia, Respiratory Therapy, IV Therapy, EKG, Switchboard Operators.

BERKSHIREMEDICALCENTER

Emergency Resuscitation Policy and Procedure

TABLE OF CONTENTS

PAGE

1. Members of the Resuscitation Team...... 2

2. When to Discontinue Resuscitation Efforts...... 2

3. Responsibility of the Switchboard Operator...... 2/3

4. Responsibility of the Nursing Staff on the Unit...... 3

5. Responsibility of the Crisis Nurse...... 4

6. Responsibility of the Critical Care Charge Nurse...... 4

7. Responsibility of the House Officer in Charge-Senior Resident..4/5

8. Responsibility of the House Staff...... 5

9. Responsibility of the Anesthesiologist or his/her Delegate...... 5

10. Responsibility of the Attending Physician...... 5

11. Responsibility of the Respiratory Therapist...... 5

12. Responsibility of the IV Therapist...... 5

13. Responsibility of the EKG Technician...... 6

14. Responsibility of the Orderly/HNA...... 6

SPECIFICS:

I.MEMBERS OF THE RESUSCITATION TEAM.

Experience has demonstrated the necessity of having one person in charge of resuscitation measures. The Senior Medical Resident on the Mayday Team will assume this responsibility. When a patient on the Surgical Service is resuscitated, a Senior Surgical Resident (PGY 3-5) if present at the Mayday will assume responsibility for directing the resuscitation. However, he/she may defer to another physician if such a change would be beneficial to the patient.

Team members in direct attendance:

A.One Senior Medical Resident or his/her designate.

B.One Junior Medical Resident (on call or designee).

C.One Junior Resident if assigned to nursing unit.

D.One Critical Care Charge Nurse or his/her designate.

E.One Primary Nurse caring for the patient.

F.One Crisis Intervention Nurse.

G.One Respiratory Therapist.

H.Two IV Therapists.

I.One EKG Technician.

J.One Orderly or HNA.

K.One Surgical Resident assigned to ICU rotation. (Evenings or nights both 1st and 2nd call Surgical Resident.)

The Nursing Department Director or Charge Nurse should be available to assist in expediting matters necessary. An Anesthesiologist should be called per Critical Care Charge Nurse responsibilities (See VI below).

II.WHEN TO DISCONTINUE RESUSCITATIVE EFFORTS.

This is the decision of the physician in charge. This is generally based on no cardiac or respiratory response after adequate application of resuscitative measures.

III.RESPONSIBILITY OF THE SWITCHBOARD OPERATOR.

A.Mayday calls come to the switchboard. Calls on this extension have priority over all other calls. (Extension 2313)

B.The switchboard operator will verify the information with the caller and then page Mayday, identifying the floor and station. For example:

"Dr. Mayday - 4 East"

This is to be repeated three (3) times and then repeated again after a short interval.

C.For Maydays in Critical Care, a direct alarm is connected with the switchboard, eliminating the need for a telephone call.

D.The physician, nurse members of the Mayday Team, IV Therapy and Respiratory Therapy should be called on their beepers.

E.During the night hours, particularly 11:00 p.m. to 7:00 a.m., it is essential to notify the Medical Department House Staff on call for the Units and the Surgical Staff on call. Other House Staff involved can be called by the floor.

IV.RESPONSIBILITY OF NURSING STAFF ON THE UNIT.

A.Know the signs of impending and definite cardiac and respiratory arrest. Recognize the need for cardiopulmonary resuscitation. Know your patients.

B.When a patient arrests, start cardiopulmonary resuscitation immediately. DO NOT DELAY. Do not cease CPR until relief arrives and takes over for you.

C.Call for help - note time.

D.If other patients are present in the room, seclude the arrested patient.

E.When help arrives, the second person should:

1.Call the switchboard, ext. 2313. "Dr. Mayday, Floor and Unit." May be delegated to Unit Coordinator or Unit Assistant.

2.Transport emergency equipment to the scene.

3.Arrange area for maximum working space.

4.Assist with cardiopulmonary resuscitation.

F.When further help arrives, the Team will continue these measures:

1.Inform the Mayday Team of any pertinent information, diagnosis, time of arrest, etc.

2.The nurse assigned to the patient remains with the patient to assist as recorder and to assume an active role in the Mayday process.

3.Another nurse should be available to obtain additional supplies as needed. Also notify the Attending Physician as soon as possible.

4.Document treatment and outcomes in the patient's medical record.

5.Return emergency medication box to pharmacy for restocking.

V.RESPONSIBILITY OF THE CRISIS NURSE.

A.The Crisis Nurse is to serve as a clinical resource and support person to the Staff Nurse/Clinical Unit.

B.The Crisis Nurse will assume the role of Medication Nurse and will function in collaboration with the Staff Nurse, Critical Care responding nurse and the Supervisor/Director of the Unit/Shift.

C.Following the emergency, have the nurse in charge fill out the Resuscitation Protocol Sheet. The original form becomes part of the Doctors' Orders. One copy is to be sent to the Pharmacy and one copy to the Director of Critical Care.

D.Assist with restocking the Mayday Cart with supplies and equipment available on the Unit. The Charge Nurse of the Unit will replace all other items.

VI.RESPONSIBILITY OF CRITICAL CARE CHARGE NURSE.

A.Report to Mayday scene.

B.Be certain ICU Coordinator brings ICU LifePak-12 to Mayday scene.

C.Prepare electrodes for monitoring.

D.Prepare for defibrillation by opening defib pad pack.

E.Prepare an IV infusion, if one is not already running, and delegate to IV Therapist. (This may be started by the physician or any qualified registered nurse.)

F.Prepare for Endotracheal Intubation if patient requires this. Request STAT Page for Anesthesia if assessment by Charge Nurse warrants.

G.Prepare medications for administration in the event the Crisis Nurse is not available. Do this as quickly as possible and document times given.

H.Assist as necessary until the emergency has been resolved.

I.Request all persons not directly involved to remain outside the room.

J.Notify Critical Care of the patient's condition and estimated time of arrival post resuscitation.

VII.RESPONSIBILITY OF THE HOUSE OFFICER IN CHARGE-SENIOR RESIDENT.

A.Report to the scene.

B.Delegate the necessary tasks to the Team members.

C.Delegate notification of situation to patient's Attending Physician.

D.Evaluate the patient's response to resuscitation and give direction for further treatment.

E.The House Officer in charge may delegate responsibility for supervising the Mayday to an Attending Physician or fellow Resident.

F.Decide when to cease resuscitative efforts.

G.Notify the patient's family if Attending Physician is not available.

H.Notify the Medical Examiner when indicated.

VIII.RESPONSIBILITY OF THE HOUSE STAFF.

A.All House Officers assigned to the Mayday Team proceed to the scene.

B.All physicians, medical students and auxiliary personnel not in direct attendance to the patient will be asked to leave the immediate area.

C.Delegation of tasks will come from the physician in charge, the Senior Medical or Surgical Resident.

IX.RESPONSIBILITY OF THE ANESTHESIOLOGIST OR HIS/HER DELEGATE.

A.Report to the scene if called. Once on the scene, Anesthesia will assume responsibility for airway management.

B. Intubate the patient if necessary.

C.Be available to assist as needed.

X.RESPONSIBILITY OF THE ATTENDING PHYSICIAN.

A.If the emergency involves his/her patient, the Attending Physician may take charge if he/she chooses.

B.Notification of the patient's family.

XI.RESPONSIBILITY OF THE RESPIRATORY THERAPIST.

A.Report directly to the scene.

B.Be available to provide assistance as directed by the physician in charge.

C.Only one (1) therapist should remain at the scene. All others should resume their duties.

XII.RESPONSIBILITY OF THE I.V. THERAPIST.

A.Report directly to the scene.

B.Begin IV infusion as directed by the physician in charge. Remain available.

C.Only one (1) therapist should remain at the scene. All others should resume their duties.

D.Assist with dispensing drugs from the Emergency Medication Box if necessary.

XIII.RESPONSIBILITY OF THE EKG TECHNICIAN.

A.Report directly to the scene with the EKG machine.

B.Be available to provide assistance as directed by the physician in charge.

C.Prepare the patient and do tracing as requested.

D.Only one (1) technician should remain at the scene. All others should resume their duties.

XIV.RESPONSIBILITY OF THE ORDERLY OR HNA.

A.Perform CPR.

APPROVED:

______

Chief Operating Officer

______

Chief of Staff

______

Chairperson, Critical Care Committee

EFFECTIVE:October 15, 2006

REPLACES:BMCP TX.C.1 - Emergency Resuscitation Policy and Procedure - March 9, 2004

PREPARED BY:John Gottung Department Director, Critical Care