My TCU CPR policy

Nurses Safety

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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 stimulus so it's essentially saying no pulse means dead)

Is this common?

Specializes in ICU.

Agree, it would really shock me if this is really the policy. You are basically treating your full code pts like DNRs. I believe this is called "failure to rescue." and yes that, would put your license in jeopardy.

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Specializes in ICU.

Also again, what is "TCU"?

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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.
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hhern, 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.

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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.

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Specializes in Emergency, Telemetry, Transplant.
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.

One 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).

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.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
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.

I 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.

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.

http://www.jointcommission.org/report_a_complaint.aspx

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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.

I 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.

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!

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How would you possibly know that the person had passed the point of no return? If no pulse present, chest compression must begin.

And what do you mean by "clarify?" I typed the policy word for word.

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Specializes in NeuroICU/SICU/MICU.

That policy is scary, and frankly, the nursing home is opening themselves up to a lot of liability if a full code patient arrests and compressions/intubation/code drugs are not initiated per their wishes. As another poster asked, are family members and patients made aware of this policy? The policy basically says that all patients admitted, regardless of their wishes, become DNRs upon admission. I have not heard of any healthcare facility having a policy like this and can't fathom the facility's reason for having that policy. You seem to think it's a money issue, but it seems to me they would make more money from living, resuscitated patients than from dead ones.

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Obviously dead, then CPR is only going to accomplish giving the person doing compressions their cardio workout for the day.

But a flat "if they don't have a pulse, don't do CPR" rule is the dumbest policy I've ever heard. If they had a pulse, you wouldn't be doing CPR anyway.

I think the person who wrote the policy was trying to go for the "Don't do CPR if they're obviously dead" rule and ended up inadvertently making everyone a DNR.

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Specializes in NICU.

"Obviously dead" needs to be defined? How can you tell the difference between 3 minutes and 30 minutes dead?

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