Revived when there was a DNR/AND code status - page 3

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   not.done.yet
    Allow Natural Death. Guessed it for myself. Not an an acronym widely used in these parts.
  2. by   lifelearningrn
    Shouldn't the DNR status be readily visible the moment she signs the documentation? Was that during your shift? If not, I don't see how you're anymore responsible for the start of the code than the admitting nurse, or the nurse that obtained the paperwork for not placing the bracelet on the patient. You were not in the room when the code started, you did not initiate the code. You notified them immediately when you were made aware they were doing CPR on your patient. The biggest mistake I see here is that you didn't document immediately. I've never heard of leaving without documenting..
  3. by   Crush
    Quote from lifelearningrn
    Shouldn't the DNR status be readily visible the moment she signs the documentation? Was that during your shift? If not, I don't see how you're anymore responsible for the start of the code than the admitting nurse, or the nurse that obtained the paperwork for not placing the bracelet on the patient. You were not in the room when the code started, you did not initiate the code. You notified them immediately when you were made aware they were doing CPR on your patient. The biggest mistake I see here is that you didn't document immediately. I've never heard of leaving without documenting..

    Not documented = not done. Do not add on an addendum without first consulting legal on how to do it first. But I am thinking too much time may have passed.
  4. by   Genmarie93
    Being a lowly nursing student admittedly knowing little about real life nursing, may I ask why you did not chart immediately on something so serious? I never considered leaving before charting as a possibility.
  5. by   Julius Seizure
    I highly recommend that you submit a report on this situation, using whatever incident reporting system that your hospital uses (they seem to have different names everywhere). Risk management needs to be made aware of this ASAP.
  6. by   GaryRay
    Quote from Genmarie93
    Being a lowly nursing student admittedly knowing little about real life nursing, may I ask why you did not chart immediately on something so serious? I never considered leaving before charting as a possibility.
    nursing school is going to do a great job of teaching you how to pass the NCLEX. The official answer is she didn't leave the room, use the bathroom, eat breakfast, administer medications, attend to her hypoglycemic patient, or reconnect a patient's circuit who's vent was alarming before she documented everything exactly the way it happened as if God himself had been in the room.

    After you pass NCLEX the answer is: patient care always comes before documentation. If you can document in real time, DO IT, but odds are your assignment is rarely going to allow you to.
  7. by   GaryRay
    Quote from not.done.yet
    Allow Natural Death. Guessed it for myself. Not an an acronym widely used in these parts.
    I think we use AND more in peds because DNR has a stigma and scares the parents. They associate it with hospice and "giving up" and when someone's kid is dying they aren't much for a lesson on the misconceptions of hospice and DNRs

    "Allow a Natural Death" sort of relieves them of the guilt they unfairly impose on themselves. I've read studies showing families are more likely to agree to an AND then a DNR in the same types of terminal cases. But I haven't heard of it being used much in the adult world.
  8. by   Here.I.Stand
    Quote from GaryRay
    nursing school is going to do a great job of teaching you how to pass the NCLEX. The official answer is she didn't leave the room, use the bathroom, eat breakfast, administer medications, attend to her hypoglycemic patient, or reconnect a patient's circuit who's vent was alarming before she documented everything exactly the way it happened as if God himself had been in the room.

    After you pass NCLEX the answer is: patient care always comes before documentation. If you can document in real time, DO IT, but odds are your assignment is rarely going to allow you to.
    I have knowingly left holes in my charting on days like those... But on something like this, if nothing else but to CYA? Should at least made a note that code was in progress and that she reminded the doc of the DNR.
  9. by   Crush
    There are times where we cannot chart right then immediately but on something so serious especially, I would have stayed over and not left without some good CYA charting.
  10. by   MunoRN
    Quote from Crush



    Not documented = not done. Do not add on an addendum without first consulting legal on how to do it first. But I am thinking too much time may have passed.
    Any reasonable risk manager would have responded that they aren't going to "consult" you on how to write your note, that opens up a huge can of legal worms. They will remind you to chart accurately and appropriately, but not on what you should chart. And in general, there's not really a time limit on when something can be documented, having something documented late is always better then not at all.
  11. by   Tenebrae
    I'm aware that due to my own personal biases I may be projecting a little here.

    My brother in law just died from pancreatic cancer and my mum has terminal lung cancer. She has made her wishes known to us kids, and has an advanced directive on file.

    If a health care team over-rid that and proceeded ignore that and to resuscitate her I would be beyond next level angry and out to make sure heads roll. All that would happen is her ribs would break due to bony mets and if she was successfully bought back would be in even more pain than she is now

    To prevent this happening again I suggest you become very familiar on the policy regarding patients who are DNR and what needs to be done to ensure that all member of the healthcare team know the patients resus status and this doesn't happen again

    The patient didn't want to be resuscitated. The doctors and the medical team thought they knew better and her resus status wasnt communicated properly. Sorry I dont have anything reassuring to say.
  12. by   Here.I.Stand
    (((Hugs))) Tenebrae
  13. by   ambersky004
    [QUOTE=GaryRay;9716390]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.[/QUOTE

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