Full Code patients in Long term care

  1. Occasionally in Long term care you have the family who Keeps their loved one on Full Code, even after patient is nearing their "End of life"
    Sometimes Patient has chronic illness or no quality of life but family members think they need to "do everything for their parent"

    My question (although may seem like a dumb question)
    If Patient passes away, and they are not found (say in the middle of the night) right away, they are Obviously deceased. Are you suppose to do CPR no matter what/when you find them? Is there ever a time you dont do CPR?
    What is the Ethical/responsible/ proceedural thing to do?

    Bea
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  2. 13 Comments

  3. by   bluegeegoo2
    If they are a code, you code no matter what. The only time you don't code is if they have a OOHDNR or the RP is there and says not to. Then you document the RP's statements verbatim.
  4. by   fibroblast
    I would think that a 'full code' means that the family of the patient still has hope in that life can be preserved or prolonged somehow. Even with an end-stage liver/renal patient, they choose to be a full code. I take it as, let them be, full code = CPR no questions asked.
  5. by   Glycerine82
    You code them, even if they are stiff as a board and blue.
  6. by   Blackcat99
    Quote from Glycerine82
    You code them, even if they are stiff as a board and blue.
    In the old days, we didn't code them if they were as stiff as a board and blue. But yes, now I hear that even if you find them as stiff as a board you are still suppose to code them. I haven't had to do that yet (to a stiff as a board body) Thank God.
  7. by   Blackcat99
    Quote from fibroblast
    I would think that a 'full code' means that the family of the patient still has hope in that life can be preserved or prolonged somehow. Even with an end-stage liver/renal patient, they choose to be a full code. I take it as, let them be, full code = CPR no questions asked.
    Yes, the kidney dialysis residents at my facility are all full codes. I have only known one kidney dialysis resident who was a DNR at my facility in the past.
  8. by   CapeCodMermaid
    In Massachusetts if there is obvious rigor we don't have to do CPR. This is relatively new. Oh yeah... They added if they've been decapitated we don't have to do CPR.
  9. by   fibroblast
    Quote from Blackcat99
    Yes, the kidney dialysis residents at my facility are all full codes. I have only known one kidney dialysis resident who was a DNR at my facility in the past.
    The codes that have occurred on our rehab floor (also long term) where dialysis patients (same day receiving dialysis as well). This has made me more aware of the condition changes coming from dialysis.
  10. by   kbrn2002
    Sadly if the resident is a full code we must initiate the code as soon as they are found down. Doesn't matter if they're obviously dead, start CPR anyway. Fortunately first responders aren't too far out so they usually get the ok to stop the code not long after they arrive.
  11. by   ltcnurse4u
    You need to check with your DON and what the facility policy is. From my experience, every place (and state) can differ. If your patient is a full code, then you must do everything to sustain life. You find the resident is respiratory distress or having a heart attack, they still have a heartbeat or still breathing then you must intervene. If you find a resident who is absent of any signs of life i.e: no heartbeat, no breath sounds, no response to painful stimuli, they are cold to touch, eyes fixed..ect..then no, I would not do CPR. Again check your facility's policy and procedures.
  12. by   Nascar nurse
    Right out of the newest rules of participation - federal regulations =CPR will be started unless a valid DNR order is in place or obvious signs of irreversible death (e.g. rigor mortis, dependent lividity, decapitation, transaction or decomposition) are present OR initiating CPR could cause injury or peril to the rescuer”.

    1. Your state rules may supersede this.
    2. You will want to make sure your policy backs you up on this
    3. You'll want to document your butt off to cover yourself if you decide to do this.
  13. by   CapeCodMermaid
    Right before I left my last place of employment, I got into an argument with the interim administrator. He was telling the nurses they MUST do CPR even if the patient signed a DNR or a MOLST indicating no resuscitation if the doctor hadn't signed the order. I said that I would rather take a tag from the DPH than go against a patient's written wishes. It's very easy for people who aren't clinical to pass judgment on those of us who deal with this every day.
  14. by   Nascar nurse
    Quote from CapeCodMermaid
    Right before I left my last place of employment, I got into an argument with the interim administrator. He was telling the nurses they MUST do CPR even if the patient signed a DNR or a MOLST indicating no resuscitation if the doctor hadn't signed the order. I said that I would rather take a tag from the DPH than go against a patient's written wishes. It's very easy for people who aren't clinical to pass judgment on those of us who deal with this every day.
    This is actually addressed in the new rules of participation as well. It essentially states that that you are to follow the resident/responsible party wishes if you have been unable to get a physician written signature.


    Again, you'd want that in your policy, you'd want 2 documented witnesses if this was only verbal instructions and you'd want to document your butt off to cover yourself.

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