DNR

[XNavyCorpsman]

My patient did not have a code status in the medical record so I asked him what his wishes were and he said he did not want anything done. He was very adamant that he did not want anything done. The hospital policy is that if the medical record does not have a code status, the patient is than a FULL CODE until the doctor enters it into the record. If this patient had a heart attack I would be required to do CPR because of the policy but I am not being a patient advocate by doing so. What do you think of this situation?

[Farawyn]

Nothing new.

Legalities are legalities.

[OCNRN63, RN]

My patient did not have a code status in the medical record so I asked him what his wishes were and he said he did not want anything done. He was very adamant that he did not want anything done. The hospital policy is that if the medical record does not have a code status, the patient is than a FULL CODE until the doctor enters it into the record. If this patient had a heart attack I would be required to do CPR because of the policy but I am not being a patient advocate by doing so. What do you think of this situation?

Be a patient advocate, then. Talk to the physician, tell him/her of the patient's wishes, request order for DNR, assist patient in filling out advance directives if he is competent to to so. Notify family of patient's wishes.

Homework?

[nutella, MSN, RN]

My patient did not have a code status in the medical record so I asked him what his wishes were and he said he did not want anything done. He was very adamant that he did not want anything done. The hospital policy is that if the medical record does not have a code status, the patient is than a FULL CODE until the doctor enters it into the record. If this patient had a heart attack I would be required to do CPR because of the policy but I am not being a patient advocate by doing so. What do you think of this situation?

Only a physician/NP can change an order from full code to DNR/DNI. This usually includes a discussion between the provider and the patient in which the implications need to be discussed.

It is part of Advanced Care Planning.

If the order is given in the hospital, the pat still needs a form to make it effective outside of the facility.

So your job is to inform the provider that the pat wishes to discuss the code status. Unless you have it in writing as an order, the patient will be full code.

[KelRN215, BSN, RN]

Call the MD, request that he/she have a discussion with the patient and then enter the DNR order.

[Penelope_Pitstop, BSN, RN]

Um, one of my bugaboos...

Cardiac arrest and heart attack are not the same thing.

But I digress...

I would document the conversation with the patient in the progress notes, after I made a call to the patient's admitting provider.