Full Code required for surgery?

  1. This is a new one for me, so I'm wondering how prevalent this is.

    I work in an LTACC, that is based within a host hospital. In order for our patients to have any surgical procedure, they have to be FC.

    Lots of times we send a pt down for surgery, that requires intubation, they fail to wean, and we get them back a few days later, still intubated or trached and pegged. Often said patient was DNR or DNI prior to surgery, and they get re admitted to us as FC.

    having come one from a big acute care hospital where this was not the case, it seems strange and unethical to me. Anyone else see this policy where they work? Thoughts?
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  2. 30 Comments

  3. by   Sour Lemon
    Quote from KDPatty
    This is a new one for me, so I'm wondering how prevalent this is.

    I work in an LTACC, that is based within a host hospital. In order for our patients to have any surgical procedure, they have to be FC.

    Lots of times we send a pt down for surgery, that requires intubation, they fail to wean, and we get them back a few days later, still intubated or trached and pegged. Often said patient was DNR or DNI prior to surgery, and they get re admitted to us as FC.

    having come one from a big acute care hospital where this was not the case, it seems strange and unethical to me. Anyone else see this policy where they work? Thoughts?
    I've only worked in acute care and this has been the case at the three hospitals I've worked at. DNRs were/are required to be suspended for surgery. I always assumed they were back to their original status after surgery, but being in med/surg, patients with outcomes as bad as the one you describe would not have come back to me post-op. Interesting scenario.
  4. by   KDPatty
    That's so weird to me. I know my old hospital, I sent a patient down for surgery, as a DNR, his blood pressure tanked and they weren't able to bring it up and he "expired" in the OR. My concern is that the code statis isnt reverting post op. Right now I have a PT who I know was adamant DNI with an ET tube. I sent her to surgery, so I know she was pretty particular on this and her daughter, who is signing authority, was supportive of it.
  5. by   morte
    the surgeons don't want the death on their record, you know the saying "no one dies in the OR"...
  6. by   JKL33
    Quote from morte
    the surgeons don't want the death on their record, you know the saying "no one dies in the OR"...
    Nor should they, now that we have decided to potentially crucify their reputations for same.
  7. by   elkpark
    I can top that -- in the large academic healthcare system in which I currently work, anyone who comes in as a suicide attempt is automatically a full code, even if that person has had a legitimate DNR order for years. It's automatically voided by any attempt to harm yourself, as far as my employer is concerned. I don't know if that's a state-wide thing or just my employer.
  8. by   roser13
    In our ASC where all surgeries are elective, no one is a DNR. Even though we ask for their Living Wills (Medicare requirement?), they will not be honored.
  9. by   AJJKRN
    Where I'm at the patient is a full code for 24 hours after their surgery then their previous code status resumes (after the MD follows up and changes it back anyways).
  10. by   brillohead
    My hospital has "levels" of code status: Full Code; Intubation OK but no CPR; No Intubation or CPR but Meds OK; and Comfort Care Only.

    In order to go to surgery, they have to at least be changed to "Intubation OK but no CPR" because they can't intubate them for surgery without that change.

    I'm not sure what happens with failure-to-wean patients in my facility, but I would hope that if they regain consciousness they can indicate their desire to extubate and resume DNR status, or if they don't regain consciousness, that their Patient Advocate or Legal Guardian or Next of Kin would be kind enough to make the right decision to extubate and resume DNR status.
  11. by   Rose_Queen
    This is a discussion that should be taking place between the surgeon and the patient, the anesthesia provider and the patient, and as a team. In any acute facility, the order for a DNR must be written/entered. Orders from another facility don't qualify. Now, if someone were to come to surgery with a DNR order, there is often a discussion with the anesthesia provider about the use of reversal agents and certain terms for remaining intubated. Many patients simply rescind the DNR during the surgical period. Others are agreeable to pretty much anything but actual compressions.
  12. by   Fiona59
    We honour their status. If you came in with goals of care, we honour it.

    If you die post op, there is an autopsy.
  13. by   TriciaJ
    Quote from elkpark
    I can top that -- in the large academic healthcare system in which I currently work, anyone who comes in as a suicide attempt is automatically a full code, even if that person has had a legitimate DNR order for years. It's automatically voided by any attempt to harm yourself, as far as my employer is concerned. I don't know if that's a state-wide thing or just my employer.
    That's bizarre. What's the rationale?
  14. by   Jolie
    Quote from TriciaJ
    That's bizarre. What's the rationale?

    My guess is that individuals who have attempted to kill themselves are not considered legally competent to make their own treatment decisions.

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