My DON has asked me about doing a new policy on CPR. She says that we need one that covers both witnessed and unwitnessed CPR, implying that if a long time has passed we would not institute CPR on a resident who does not have a Do Not Resuscitate. Does anyone have any ideas on this? I am uncomfortable differientiating the two situations. Too many variables and too much liability.
Jan 20, '00
Judy -- you are wise to be cautious.
First, do you have access to your corporate counsel? The law firm that represents your facility could be of great assistance to you on this matter.
Second, what is your policy on DNR -- does every resident have to have SOMETHING in writing about end-of-life guidelines or treatment restrictions? If not, this may be a better place to start. It's always best to be sure you are acting in concert with the patient's wishes.
Finally, who calls a code in your facility? Who ends a code? Your policy decision tree on whether to start CPR should surely include the qualifications of that person -- once you start, there's no going back. Whether to start is just as significant a decision.
Good luck in this quest. I'll be anxious to see what other LTC facility experts add to this discussion!
Jan 23, '00
This need for this type of policy would make me warry. Why does she want two????? CPR is to be done the same in all situations unless you have an order to differentiate that such, as do not intubate. I don't think you can change much. I would call the Amercian Red Cross and ask. I don't think it is the nurses' role to determine who should receive what care in this situation. That would require a medical diagnosis which nurses are not allowed to do. Give more info.
Feb 2, '00
Thanks to Tara and Pathfinder for your responses. I think we have settled the issue as it is really clear cut. Either they are a documented DNR or else we begin resusitation efforts and ship out to the hospital. As we are LTC, there is rarely the convenience of a physician in house to end the code. It is just a shame as some of our residents cannot be a DNR because they have no family and the court will not do the DNR. We do occassionally find them after so much time has passed that we know our efforts are futile and we feel bad about putting them through the trauma that follows.
May 29, '00
I am bringing back a previous topic. This is an interesting point. I have worked in 2 LTC facilities in Milwaukee and both had similar policy regarding CPR. If we witness the resident having an "event" being in the room with the person when respirations cease, and the person is a full code, we start CPR. If we are doing rounds, and find one of our full code resident's pulseless and non-breathing, we do not start CPR. The resident and/or the family member sign this on admission, and when the resident is first staffed we go over it.
It seems almost cruel to attempt CPR on those frail bones.
Another thing we do, is my SW and I speak to those who are full code and explain what occurs, that has helped. NA
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