unresponsive patient

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    My old facility started a policy that a code blue is to be called on all unresponsive residents. Its confusing because it says charge nurse is to get the chart and start CPR if non-responsive and full code. They also say a nurse cant assess criteria for death and then call MD for an order. Anyone have familiarity with a policy like this?
  2. 8 Comments so far...

  3. 0
    all i can say is "huh?" can you explain more, please?

    suebird
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    People can be unresponsive and still have respirations and a heart beat! They don't need CPR. Always assess ABC's prior to starting CPR - Not LOC. In my facility we are required to call physician and report absence of all vital signs and they give us an order to release body to funeral home and a statement that they (the physician) will sign the death certificate. Does this help?
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    This is just plain dumb!!! If your patient is unresponsive but breathing and has a heartbeat ...you can not do CPR...LAWD Slap some O2 on and send them to the ER.



    Quote from beaglelover
    My old facility started a policy that a code blue is to be called on all unresponsive residents. Its confusing because it says charge nurse is to get the chart and start CPR if non-responsive and full code. They also say a nurse cant assess criteria for death and then call MD for an order. Anyone have familiarity with a policy like this?
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    I would assume that they wish to have a code blue called just in case of code (best to have equipment and staff on the way to save seconds where seconds count). However, you do not jump into anything untill assessment is done...remember your ABC's of CPR...the assessment of Airway, Breathing, and Cardiac before anything.

    Now, as far as doing CPR...a nurse has the clinical judgement call to start CPR and get 9-11 activated so they may hand over care when paramedics arrive.

    They do not have a Dx of death per say...however we can say "severe failure to thrive..and describe symptoms like no pulse, no bp, no respirations, nonresponsive...etc." to an MD once the patient has passed...this is normally done with a call to the coroner who needs to be notified asap at time of death. This is certainly in a nurses best interest (or CNA) because the more time that passes makes things seem a bit funny to the family and coroner. So call when you suspect death, and what I usually did was have CNA's continue CPR efforts (what we called a 'slow code' nothing too serious, just going through the motions of compressions/breathing but not to hard as to break ribs or what not) and I would call the coroner and ask to stop CPR efforts according to my assessment data.

    Now remember, CPR on a DNR is not to be done if they are dead..and only dead...I mean not breathing AND no pulse! If an unreponsive patient is breathing or has even a slight pulse..you continue CPR. DNR is do not treat...it is do not bring back from death.

    And one more thingie here that is good to remember from time to time...remember the cases where someone can be unreponsive and not need compressions or rescue breathing...seizures (or post...just maintain airway or breath dependant), some TIA's, blocked airway, fainting, etc..... Makes assessment seem pretty important huh...
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    Let me elaborate on this...this facility wants CPR done even if a resident meets criteria for death!!!! This happened when a resident was found with pupils fixed, mottled, very cold to touch, no resps, no pulses, etc....She was found by a CNA at change of shift who grabbed a nurse who didnt know her and asked for help. She could have been waiting for the funeral home for all anyone knew at change of shift. She happened to be a full code. But Md was called and she said dont do CPR. Anyways, all 4 nurses who saw her were fired and reportedly reported to the BON! Anyone ever hear of something like this before??? This nursing home/cya culture has gone too far.
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    Okay...here is the story.

    If a person is obviously dead...no pulse, no breathing, blue/grey, stiff, non responsive to anything..and a doctor gave an ORDER to stop CPR...you stop CPR! However, a nurse does have the judgement call to wait for paramedics to arrive to assess the patient with an EKG to establish pulse and what not. A paramedic then can stop CPR efforts by protocol or their advice MD.

    That is why if I had any doubt I would do CPR efforts (not in cases of DNR when I was assured of death) till paramedics arrived and did an EKG at least. I have done this once...the patient was dead, however...to protect myself of any wrong doing, I felt better safe than sorry and initiated CPR efforts..also the poor husband was right there and it was the right thing to do so that he knew that we were doing all we could.

    So those nurses, given they had a MD ordered stop CPR ORDER...they were right. This order must be given to an RN in order to be legal, and a telephone order must be submitted for MD signature. This will be quantified by the BON because State laws always outweigh facility policy!

    The MD order stands in this case...if there was any doubt that the patient may still be alive, then they should continue CPR efforts till paramedics arrive to assess via EKG (in 3 or more leads) that death has occured.

    They didn't do wrong in my book, and being fired and threatened is totally wrong! I would take that to the BON myself and potentially press charges on the employer if any smudge was on my record!!!
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    Also...just wait till that employer is sued for doing CPR efforts on a DNR (death criteria only). I have seen this done by family members and patients who do NOT want to be brought back from the dead to live in even worse shape than before they technically died!

    IF that happens...they will switch gears like crazy and proably do the opposite (like my old facility) which mandated all residents have a DNR upon entry (LTC) and then nurses didn't do anything...till I cleared things up! (yep, they didn't do anything even when the patient was technically still alive like not breathing but faint pulse!).

    Gotta love those facility policies huh!?!?!
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    They do not have a Dx of death per say...however we can say "severe failure to thrive..and describe symptoms like no pulse, no bp, no respirations, nonresponsive...etc." to an MD
    I'm sorry, and I mean no disrespect to Triage34 because it sounds like this her is facility's policy, but I'll be darned if I ever say the above, especially to a physician. That sounds like "nursespeak" run amok. Call it what it is...an arrest, whatever... but "failure to thrive"? If you've got no pulse, no BP, and no spontaneous resps., you're way past the point of "faliure to thrive."


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