A question of code status

[gpip]

The hospital I currently work at has 3 types of code status. Code A, wants everything done. Code C, do not recessitate. Code B which lets the families and patient pick and choose what they want and do not want. Some examples are intubation, feedings, blood products, defibrillation, dialysis. Is this normal across the country and for the members from other countries across the world. Do you agree or disagree with giving so many options, and why?

[CEN35]

well while that may be true to a point. what about torsades, vt with a pulse, af-rvr? there are some arrythmias that the chemicals will fix. which doesn't neccesarily make them a code....but many families, do not even want arrythmias and stuff treated. so there is a reason to be specific........just my 2 cents!!!

me :)

[cargal]

This may not help you in the hospital, but I have come across a wonderful new type of Advance Directive. It is legal in my state, and presented by the non-profit organization Aging with Dignity, at http://www.agingwithdignity.org. The Advance Directive is called 5 Wishes.

[Agnus]

Carrie, your link did not work for me.

[mattcastens]

You know, I attended a critical care symposium last week and listened to Tom Ahrens, CNS, PhD speak. (If you ever get the chance to attend one of his talks -- especially if you work in critical care -- I extremely highly recommend it!)

He brought up the fact that perhaps instead of making everyone a full code unless otherwise ordered, everyone should be made DNR/DNI unless otherwise ordered. His point was that in terms of statistics, only about 15% of coded patients (hospitalized patients) are ever discharged home and only about 5% suffer moderate to little to no neurological damage. If more than one system is compromised, the percentage approaches zero.

Seeing as how much pain and suffering this can cause to both patient and family, and considering that a leading cause of bankruptsy in the US is health care costs, we really should be educating patients and families better. Naturally, the patient or spokesperson would get the final say.

[mcl4]

Originally posted by mattcastens

You know, I attended a critical care symposium last week and listened to Tom Ahrens, CNS, PhD speak. (If you ever get the chance to attend one of his talks -- especially if you work in critical care -- I extremely highly recommend it!)

He brought up the fact that perhaps instead of making everyone a full code unless otherwise ordered, everyone should be made DNR/DNI unless otherwise ordered. His point was that in terms of statistics, only about 15% of coded patients (hospitalized patients) are ever discharged home and only about 5% suffer moderate to little to no neurological damage. If more than one system is compromised, the percentage approaches zero.

What type of paper work would be involved in making, I'm guessing, a good percentage of patients a full code and who would be responsible to ensure patients are categorized full

code or DNR/DNI. Would this system of having patients be made DNR/DNI unless otherwise ordered be done on a peds station or OB or even the station I work on where there are many younger adults having elective procedures? I'm not sure how patients or parents would react to this type of status?

I don't think it is always an easy decision making people DNR/DNI. My own experience with a family member that had a terminal disease, it took time for this person to rationalize and chose that they would not be a full code in a hospital situation. My approach with an advance directive was met with anger by this person as well as family members. This was part of the grievance process and the part of acceptance that they would die. However, I do see your point regarding the negatives for patients and families that are subjected to a code and the percentage of positive outcomes is statistically low. It is a tough situation where families are put under a good deal of stress.

I wonder if there should be more emphasis as well as education of adults on what is involved in advance directives prior to an illness when a split decision doesn't need to be made.

I see some seniors have advance directives, but not younger adults. I'm not sure how this would be done since my opinion is that the general population doesn't like to talk about death or topics related to dying; whether it be donating organs or what to do when you are in a hospital situation where the hopes of recover is not good.

[fiestynurse]

I totally agree that more education needs to be done regarding Advance Directives, DNR, and Organ donating. Again, it should be done at the clinic level long before a person is hospitalized with a serious illness. There is a big push by Ambulatory Care Accreditation organizations, such as JCAHO, to address this issue. Lately, I have seen some great education materials being given to patients of all ages.