Quote from t2kck
I re-read your note regarding documentation for a patient or medical power of attorney who makes a decision for a NO CODE status (DNR). Inconsistencies in care may depend on the variation of Code Status from patient to patient. The doctor fills out the DNR form for Code or DNR status after an indepth conversation, full disclosure and all while assuring that the patient fully understands what they are agreeing. I have been involved DNR's status in which I had options. They are as follows: Full NO CODE: NO Defib, intubation or meds are to be administered when a patient stops breathing and has no pulse (dead); Partials code status 2. Administer meds, intubate, but no defib. 3. Meds only OR defib only OR intubate only. 4. Defib, intubate but no medications. Nurses must be familiar with each individual's code status.
When a terminal patient is noted to be at the end of life, it is recommended to involve hospice if patient decides to be a full DNR or NO CODE.
Please whatever you do, DO NOT ADMINISTER everything you've got on the crash cart to a patient who died and was a DNR. DO NOT withhold care and everything you have on a crash cart to a terminal or a patient who stops breathing and has no pulse but is a full code. Mistakes happen in Codes Blues mostly by nurses who don't know the orders. Familiarize yourself. You may get in trouble.
I agree, it's imperative to know the patient's exact code status, which MUST be clarified by the MD in the form of a specific, detailed & signed order. Of course, miscommunication can happen anywhere in the hospital, but I think it becomes more of an issue for floor nurses who have many patients to care for, rather than critical care nurses who have only 2 or 3 patients. I have tremendous respect and sympathy for those floor nurses who have so many patients to care for; perhaps it would help if the charge nurse or nurse manager is also fully aware of the code status for the patients on the floor...I would think this is already the case, but not sure. I know we've had DNR patient's who were coded!
I also think it's VERY important to make sure nurses advocate for those patients who have made their wishes known and want to be a DNR. Get the doc to speak with the patient and get the orders written right away!
I've also seen emotional family members convince an MD to change a patient's DNR status when that patient can't speak for themselves!!! We had to code an end-of-life cancer patient on his 80th birthday because the family decided they couldn't let him die (as he wished) and they convinced the doc to rescind his DNR status!!! Thankfully, for the patient, he did not make it through the 2nd code just 20 minutes later. He got his wish, finally!!