Pharmacist Code Response SLLS

Once a skill becomes second nature, it’s easy to take it for granted. We often forget the struggle and the confusion we once had prior to mastery of the said skill. So every once in a while it’s useful to revisit and reassess our skills to make sure we don’t miss steps and take shortcuts. It’s also another opportunity to help those around us who may be at another phase in their mastery of a given skill. Within many pharmacy departments, code response is one of these skills that exist on a wide spectrum of ability and comfort. 

While BLS, ACLS, and PALS are essential training certifications for any pharmacist, there is a big difference between holding the card in your ID badge buddy and actually executing at a high level in a chaotic code. To learn how to improve your performance, become comfortable, and actively contribute in any code setting there is another sequence that is incredibly simple and useful to follow: SLLS or “sills.”

Borrowed from military special forces, SLLS is a technique to rapidly adapt to a chaotic environment, observe and collect data from your surroundings to gain operational control of the environment. Consider yourself being called to a cardiac arrest in progress, arriving 5-7 minutes into the situation and immediately met with demands for MORE BICARB! It’s incredibly easy to just comply with this request. It’s also not always the correct action to take.


Immediately once you arrive at the code, stop. While somewhat obvious, it is incredibly easy to forget to do so. The rush of emotions, not to mention elevated heart rate from rushing upstairs or down the corridor, makes it tempting to rush into the room without taking a moment to gain perspective on the environment.

Also critical to the resources available to the team, you must announce your arrival. Since you are an asset to the code response itself. Forgetting to do so will cause the team to continue shouting orders with multiple individuals attempting to execute the requests – all drawing away from their previous tasks.

SLLS – Look

After you’ve stopped, you can rapidly assess the environment. This brief exercise of observation can bring you up to speed rapidly and provide you with the necessary data for forming a care plan in your mind. It also reduces the number of questions you must ask another team member, allowing for chatter in the room to be kept to a minimum. Key observations could include the following questions: Is this an ICU or Med/Surg room? Is family present? Who is running the code? Is there a crash cart? Is it empty? 

SLLS – Listen

Simultaneously, while looking at the environment you’ve just entered, you can also listen to your surroundings. Doing so will provide numerous answers to the questions you’ve identified by stopping and looking at the patient room. Focusing your attention on listening can also help identify team members who may be in need of assistance. If the individual administering chest compressions is tachypneic themselves, you can offer to tap them out. If the nurse documenting code events is repeatedly asking for updates or clarification, you can help keep track of time, drugs, interventions and communicate that to the nurse. 

But in most scenarios, you’ll be met with a request for medication. It’s tempting to comply with any and every request. However, you must be the steward of good pharmacotherapy. That’s why you’re there. If the patient has received a half dozen bicarbs, the next intervention is probably not more bicarb. It’s your job to recommend alternatives and remind of interventions that may still provide some benefit.

SLLS – Summarize

While the armed forces use “smell” as the final “s” it’s not exactly necessary here. Sure, smell could provide you with contact precaution advanced warning for certain patients, but not immediately actionable information. So I like to replace smelling with summarizing. 

Take a moment, after executing SLL to summarize your observations and assessment to yourself. By doing so, you may identify H’s or T’s that have not yet been addressed. You may also come to the conclusion you’ve done everything appropriately to this point. Briefly communicating your summary to the code lead can help them determine the appropriate next steps. Don’t assume they have the information you are going to provide. There’s only one way to get on the same page.

The next time you’re called to a code, remember SLLS:

  • Stop – adjust to your new environment
  • Look – assess the surroundings, resources, personnel
  • Listen – not just to rapid-fire orders
  • Summarize – what did we miss?

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