Code Status

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    I'm trying to find a universal way for our hospital to identify code status on our patients. Currently we put the code sheet in the front cover of the chart and the MD will mark the box that is appropriate per the wishes of the patient (Full Code, No Code, DNR/Comfort Measures, Code With Restrictions, Etc.).

    My concern is that our first instinct (collectively) is to initiate CPR and call a code when we find a patient is not breathing. Worse yet, if the patient happens to be in the furthest room from the desk, we are wasting precious time running to the desk, trying to find the chart and by that time, someone might already performing CPR on the patient. Not a good thing if the patient is a No Code. But then again, precious seconds are ticking away by trying to hunt down what their code status is.

    What protocol do you guys follow at your hospital? Really interested in your input...and thanks!

    Lori
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  4. 12 Comments so far...

  5. 0
    i know some hospitals might feel that it would violate patient confidentiality, but our hospital's policy is that all patients who are a no code have a blue ID bracelet... all full codes have a red... so if you're not familiar with the patient and you walk into the room, you can quickly determine if they're a code or not just by looking at the bracelet...

    ETA: we also have code status' posted behind the main nursing desk, on the patient's charts and on the daily worksheets we get at the beginning of shift...

    beth
    Last edit by Kudra on Jun 21, '04
  6. 0
    Quote from Kudra
    ....all patients who are a no code have a blue ID bracelet... all full codes have a red... so if you're not familiar with the patient and you walk into the room, you can quickly determine if they're a code or not just by looking at the bracelet...
    Thanks for the input, Beth. It's appreciated. As part of a "Code Idenitification Committee" at our hospital, I'm trying to gather ideas on how other facilities operate. Do you guys also use red armbands when a patient is Type/Screened for blood transfusions?

    I'm also leaning towards the idea of armbands, but feel the patients are going to have an armfull of "bangles" by the time they are discharged. We use so many of them! ...armbands for patient identification upon entry to the ER, one for barcoded medication administration, one for being typed/screened/blood transfusion, one for allergies... I'm thinking if we can combine them on one armband, life would be simpler not only for the patient but for the nurses as well.

    <Sigh> The quest continues....
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    We use blue armbands for DNR's. When the armband is placed on the pt, two licensed nurses must witness and sign in the nurses notes that it is the correct pt, etc. The code status is also posted in the room on the chart/flowsheet, the chart at the nsg station and we also write it in on our report sheets that most of us keep in our pocket. As for the multiple armbands, well, we take off the armband from the ER once they are admitted to our floor, and we don't have an armband for blood or allergies or barcodes. (We take the MAR sheet with the med we are giving into the room to do our checks, it has the allergies written on it.) The most armbands we ever have is three: if the pt is a "DNR" we have a blue, if they are a fall risk we have a yellow and then the regular white band that all patients have.

    I'm thinking your best bet is to combine some of your info onto one armband.
  8. 0
    Quote from RNeyez
    Do you guys also use red armbands when a patient is Type/Screened for blood transfusions?
    no, we use a clear yellow one for T&S's... but they're removed every 3 days when the T&S expires...

    i can see that you would be hesitant to use an armband system when you already have so many... we basically have the ID bracelet (blue or red), orange allergy bracelet and a T&S (if necessary)... not so much to contend with...

    beth
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    We also use armbands...and we have a big orange sheet in the chart that states code status (which is only occassionally filled out...but usually written somewhere else in the chart, they are new so we are still trying to get the docs to utilize them). We have green armbands for type/cross...our typical armband background color is blue (full code), we have other colors for no code and limited codes, etc. We have pink for lymphedema/mastectomys, etc if an am has a pink band on it, we know that means no venipuncture/BP/IVs in that side. Our monitor tech also as a "code" sticker up next to the patients that are no codes on her/his monitor.
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    Quote from zambezi
    We have pink for lymphedema/mastectomys, etc if an am has a pink band on it, we know that means no venipuncture/BP/IVs in that side.
    Along the lines of armbands, I really wish our hospital would begin using those. Thanks for all the feedback, guys...It all helps.

    Ahh...wouldn't life be somewhat easier if I could go back to the flowsheets at the bedside, but alas...this hospital is as paper-free as possible...no paper MARS, no flowsheets, no paper nursing notes, etc. (wait a minute...what AM I thinking!!!~~~I'd rather type my notes than write them!!!) Seriously though, the only thing on paper are the MD orders, everything else is computerized charting and computerized medication delivery (so-to-speak).
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    but it seems like that at our hospital, they, at least used to, put butterfly stickers above the bed plus have a purple arm band on the DNR patients. That way, as soon as you walk in the room, you know what their code status is. Just a suggestion.

    Pam
  12. 0
    We use blue armbands instead of white ones when a patient is a DNR.
  13. 0
    I've tried repeatedly to get armbands indicating code status instituted at my hospital, but to no avail "because it could violate HIPAA". :stone Sometimes I think TPTB use HIPAA as an excuse for everything.....I can't believe the act was meant to disrupt the health care system as much as it has, but that's a topic for another thread. :angryfire

    Currently, we use red tabs inside the front cover of the patient charts denoting their code status, plus we also mark it in red on the team worksheets inside the nurse-server doors. This is, of course, when busy unit secretaries, unit aides, and nurses alike don't forget to write it in when making out the worksheet, which usually happens when confused elderly pts are admitted who don't have their paperwork with them. It's unfortunate, because unless they come from a nursing home or assisted living facility which has a POLST or advanced directive for every resident, or have family members present who know the code status, there's no way to know for sure WHAT it is......and occasionally we wind up coding someone who for all intents and purposes shouldn't be.


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