During a code, can an RN administer advanced cardiovascular life support (ACLS) drugs if a physician or advanced practice nurse isn't present? In the small hospital where I work, the ED physician normally responds to codes. If two codes are under way at the same time, one team sometimes follows ACLS protocol, including drug administration, without direction from a physician. Is this acceptable practice?-P.W., CALIF.

In general yes, as long as the nurses have current basic life support (BLS) and ACLS training and your facility's policy and procedure supports this practice. Read your facility's policy and procedure manual to make sure code teams are in compliance under these circumstances. If the policy isn't clear, work with administration and risk management to develop or revise it.

According to the American Heart Association, the foundation of ACLS care is good BLS care, beginning with prompt, high-quality CPR and defibrillation when appropriate. Drug administration is of secondary importance; few drugs used to treat cardiac arrest are supported by strong evidence.

Source: 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, Circulation (Suppl.), December 13, 2005.