Revived when there was a DNR/AND code status - page 2

There was this experience that I will never forget in my nursing career. Patient N came back with Afib with RVR. She converted to SR during shift change. The night nurse said she had episodes of... Read More

  1. by   MunoRN
    Quote from Kyrshamarks
    Actually in most states, healthcare workers cannot be sued for not following a dnr. Furthermore the standard is when CPR is initiated on a pt you do not stop if it is discovered they are dnr. You are obligated to finish the code.
    There aren't any states where healthcare workers are protected by refusing to follow a competent patient's refusal of treatment, and that can actually fall under the realm of a criminal act. If it is discovered during the course of code that a patient does not want that intervention, then continuing the code could potentially be prosecuted as battery.
  2. by   ambersky004
    Quote from MunoRN
    There aren't any states where healthcare workers are protected by refusing to follow a competent patient's refusal of treatment, and that can actually fall under the realm of a criminal act. If it is discovered during the course of code that a patient does not want that intervention, then continuing the code could potentially be prosecuted as battery.

    What if the patient did not have any complications following survival? She consented to get a cardiac cath the next day.
  3. by   ambersky004
    Quote from Kyrshamarks
    Actually in most states, healthcare workers cannot be sued for not following a dnr. Furthermore the standard is when CPR is initiated on a pt you do not stop if it is discovered they are dnr. You are obligated to finish the code.

    I might look at our hospital policy regarding this. Thank You.
  4. by   JKL33
    Quote from Kyrshamarks
    Furthermore the standard is when CPR is initiated on a pt you do not stop if it is discovered they are dnr. You are obligated to finish the code.
    That is not true.
  5. by   JKL33
    Quote from ambersky004
    What if the patient did not have any complications following survival? She consented to get a cardiac cath the next day.
    We can't just do whatever we want to do, totally disregarding the patient's autonomy as long as we don't cause any complications.

    That said, I don't see where you really have anything to do with this. If I were you I would not take responsibility for others' actions and decisions. You may have caused yourself a bit of a problem by not documenting your stance and your advocacy of the patient's wishes, though.
  6. by   MunoRN
    Quote from ambersky004
    What if the patient did not have any complications following survival? She consented to get a cardiac cath the next day.
    I'm not sure the fact that she later consented to a different medical treatment really affects the issue with her code status not being clearly communicated. There were clearly issues with the overall process for communicating pateints' code status in the scenario you've described, and it's a little concerning that the MD did not honor the patient's initial refusal of various tests and treatments, which might explain why the MD didn't adequately communicate the patients declination of resuscitative treatments.
  7. by   ambersky004
    Quote from JKL33
    We can't just do whatever we want to do, totally disregarding the patient's autonomy as long as we don't cause any complications.

    That said, I don't see where you really have anything to do with this. If I were you I would not take responsibility for others' actions and decisions. You may have caused yourself a bit of a problem by not documenting your stance and your advocacy of the patient's wishes, though.
    You have a point. I break the pt's advocacy. I was thinking about why i didn't yell at the doctor or in the whole room to hear me. I told him she is a DNR but told me to call the doc. So the hospitalist came and she also said she is a DNR. The hospitalist did covered her butt and I did not cover my own butt. That was frustrating too.
    Last edit by ambersky004 on Feb 1
  8. by   GaryRay
    I would let risk management know, document you advised against cardioversion in the code sheet, and request a debriefing of the code. Doing a root cause analysis of how the code status was disregarded (without pointing fingers) can keep it from happening again.

    We are human, we make mistakes, this is why healthcare will never be perfect. Most doctors, when unsure, would rather get reprimanded for saving a patient who didn't want to be, than failing to save someone who did (or who's family did).

    I've worked at a lot of places who put a laminated heart or some other sign on the door and over the bed that visitors won't recognise but the staff knows means the pt is an AND. We also don't usually have them on monitors. If they are a partial code there is a neon binder at the foot of the bed (you can't miss it) with the advance directives.

    But our code status's get overturned a lot in PICU, parents think they have made their decision until their child is actually actively dying, when they see them lose consciousness, they change their minds a lot. All it takes is a verbal retraction and }POOF{ get the crash cart.

    I've never been in a situation where a pedi patient was revived against the family's wishes.... all the signage is mostly to keep out unnecessary staff to give the family privacy.
  9. by   inthecosmos
    Quote from ambersky004
    What if the patient did not have any complications following survival? She consented to get a cardiac cath the next day.
    It does NOT matter what she consented to AFTER you failed to adhere to her wishes. DNR's are legal documents and unless it was a HCPOA or the patient themselves requesting to revoke the DNR, the staff here FAILED the patient.

    If you told to DR that she was a DNR and they decided to continue with the code, then document that. You should not have went home without doing that. Documenting this far after the incident may come off as a lie or false documentation.

    Risk management should be involved.

    I wish you luck.
  10. by   Farawyn
    Quote from ambersky004
    You have a point. I break the pt's advocacy. I was thinking about why i didn't yell at the doctor or in the whole room to hear me. I told him she is a DNR but told me to call the doc. So the hospitalist came and she also said she is a DNR. The hospitalist did covered her butt and I did not cover my own butt. That was frustrating too.
    I yelled at the nurses over the phone at the nursng home to stop coding my Dad, and they didn't. If he had lived, I would have sued their asses off.
    Thank God he didn't.
    And yes, that sounds horrible.
  11. by   Crush
    Absolutely a case for risk management involvement.
  12. by   osceteacher
    Quote from JKL33
    That is not true.
    Seems a bizarre thing if true, in the UK we do commonly have the issue where we commence CPR only to find out they weren't for CPR. We then stop. Because thats the patients wishes. What an absurd notion that you should continue.
  13. by   not.done.yet
    What is AND? I have never seen that abbreviation.

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