My TCU CPR policy - page 2
Even for full code pts, my TCU CPR policy is not to do CPR if the pt is determined to be dead. The TCU protocol qualification for being dead is no pulse and no response to stimulus. (a person without pulse will not respond to... Read More
- 5May 2, '12 by hherrnQuote from unsaint77Maybe I am missing something, but I am pretty sure you got that wrong.I am going to type this written policy for you here. I saved the copy just in case.
"****** C.P.R policy and procedure
CPR will not be performed on any resident (regardless of code status) who is assessed as clinically expired by the folowing criteria, as determined by a licensed professional:
1. Absence of respiration
2. Absence of blood pressure
3. Absence of pulse
4. Absence of response to painful stimulus
a. Sternal rub - knuckle of fingers rubbed hard into sternum.
5. All above criteria must be present to determine resident is clinically expired.
Essentially, my facility prohibits me from doing CPR on a full code pt if they have no pulse.
I understand that in a normal setting, the only time chest compression is needed is in the scenario described in #4. And this policy prohibits that and directs me to call 911 instead. At best scenario, according to this policy, I can do rescue breathing if the pulse is present. But if the pulse stops in the middle of my rescue breathing, I am supposed to stop.
It sounds like my facility is not the only longterm care place doing this. (My whole building of over 100 residents and have not a single AED.) I suspect this is done because they have no financial gain from performing CPR, but potential legal problem. I know it is sad, but let's not dwell on ethics for now. By the samarithan law, I am supposed to apply my CPR skill to save people with no pulse. So, if I didn't do chest compression on a full code pt with no pulse, following the facility procedure, would my license be in jeopardy?
By your policy, no pulseless people get cpr. Anybody without a pulse will have no bp, respirations, response to pain, etc, therefore no CPR.
Under that policy, what patient would get compressions?
What on earth is the point of calling 911? They are going to attempt to resuscitate a patient that is far less viable because your staff was prohibited against providing the Standard of Care. The patient would have a better chance of surviving a pulseless arrest at a ball game.
I think this policy was written by somebody who doesn't really understand this stuff. One clue is having both criteria 4 and 5. A sternal rub IS painful stimlus. That's why it is done.
Maybe if you witness a pulseless arrest, you could get a family member to do compressions while you call 911. What a crappy position your employer has put you in.
- 2May 2, '12 by psu_213, BSN, RNI really don't understand. If an individual is a full code, they don't have a pulse, you do CPR--the same thing you would do if you saw someone go down in the mall. Are the RNs (and other staff) CPR certified? If so, there is no reason they cannot and should not do CPR.
Are the residents and their family aware of this facility policy?
- 0hhern, can you be more specific as to what you think I got wrong? Everything you said is EXACTLY what I know and what I think. Of course no pulse means no breathing and no pain response. Of course everything about this ridiculous. But according to a comment earlier here indicates that my employer is not the only nursing home with this policy. I am afraid this is the reality of geriatric care in our country. My nursing home would rather avoid some legal trouble than saving a person's life since there is no reimbursement for it. Knowing how money drives everything, I can sadly understand this, but what I don't get is how the state makes us write 4 different paperwork for one antipsychotropic med in the name of protecting the senior pt, yet they allow this kind of policy to exist. Again, my nursing home has more than 100 residents yet not a single AED.
If any of you run across this kind of crappy policy, just ignore it and perform CPR when there is no pulse until an MD or NP orders you to stop. If I get fired for doing the right thing, I will go to media with this and the public will learn something about the reality of geriatric care of this country.
- 6May 2, '12 by psu_213, BSN, RNQuote from unsaint77One hospital where I did my clinicals in school had a TCU. It was an entire floor in the hospital, so pt's who did not meet criteria for being in the hospital could be "discharged" and then sent to the TCU to finish their rehab...they, hopefully go back home (not to LTC).transitional care unit. It's for pts not sick enough for hospital but too sick to be in a nursing home or assisted living. A tcu is usually a part of a nursing home with long term care residents. My TCU has IV and TPN capacity. that's what they claim anyway.
Here's where I see the issue...this is not a "nursing home." This is not a final destination for many of these pts. They are expecting to be there for a short time and then leave alive. This "policy" seems to run counter to that thinking.
- 11May 2, '12 by Esme12, BSN, RN Senior ModeratorQuote from saint 77I am uncomfortable with this.....that policy essentially says let everyone die. PM me their name and I'll report them. At least there will be an investigation to find out this is true and understood properly. This is a TCU not a hospice unit.....I'd go to the media now. This policy is a problem.transitional care unit. It's for pts not sick enough for hospital but too sick to be in a nursing home or assisted living. A tcu is usually a part of a nursing home with long term care residents. My TCU has IV and TPN capacity. that's what they claim anyway.
NO AEDs? Wow this place needs to be closed down. go to the joint commision web site and file a complaint. Here is the link. The will investigate. Call the state.
- 4May 2, '12 by CompleteUnknownQuote from unsaint77I don't think I'm explaining myself properly. Our policy means that if we find someone who is obviously dead, we are not required to do CPR. If there is a witnessed arrest, we do CPR according to the resident's previously documented wishes.CompleteUnknown, thanks for your thought but I don't understand how you don't see this as a bad thing. If your heart stops, would you not want people to try to revive you? Your heart stop pumping does NOT mean that you cannot be revived.
If we walk into a resident's room and it's obvious that the resident has been dead for any length of time, we don't attempt to revive them because it just isn't possible. Residents and families are aware of this policy.
If a resident has an MI or other event in front of someone and stops breathing, there is no heatbeat, etc, in that case we do attempt to revive them (if that is their wish).
If we walk into a room and find someone with no heartbeat and no breathing, and we think it has just happened ('I was just in here 2 minutes ago, she was fine' situations), we would be expected to do CPR. In other words, if there's any doubt, we act. If there is no doubt, we are not required to act and in fact I think it's almost abuse to do CPR when there is absolutely no chance of success.
I'm not saying that a policy like this is necessarily appropriate everywhere, and now that you've said a bit more about the type of unit you work in, I think it's even more essential that you clarify your facility's policy immediately!