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Code Blue

Nurses   (812 Views 10 Comments)
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I've been a nurse for 4 years. I work on a med-surg unit. I have participated in a few codes, however it was always another nurse's patient - never mine.

I'm embarrassed to ask this question, but here goes:

If I find a patient without vital signs and it is NOT my patient (therefore I am not aware of their code status), do I a) start compressions right away and call a code, stopping CPR if the primary nurse indicates the patient is DNR, or b) call for the primary nurse to determine the patient's code status before starting CPR.

I assume the answer is b (starting CPR on a patient who is DNR is considered assaulting the patient), however I'm not sure.

Thanks for your help.

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The patients on my unit get a purple DNR band if they are a DNR or a white and purple band that says MODIFIED DNR if they want something, but not everything. If I walked in on a patient who wasn't mine and noted they weren't breathing, I would look for the band. If I didn't see it, I would yell for help and start CPR. We also have the DNRs/Modified DNRs written on a white board at the nurses station. Occasionally it is written on the white board in the patient's room, but not always. There are also a few patients who don't have a code status documented in their chart. They are considered a full code should anything happen.

You could also get in trouble for not starting CPR sooner. Every situation is different, but we've had DNR patients code and family changes their mind and wants you to do everything to save them.

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We have colored bands on ours as well. I would not personally delay starting CPR to call the nurse and ask, that could be the difference between breathing wa in damage or not if successful ROSC obtained. Think about BLS and ACLS you get dinged for not performing 2 min of CPR before calling for help

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If I find a patient without vital signs and it is NOT my patient (therefore I am not aware of their code status), do I a) start compressions right away and call a code, stopping CPR if the primary nurse indicates the patient is DNR, or b) call for the primary nurse to determine the patient's code status before starting CPR.

I assume the answer is b (starting CPR on a patient who is DNR is considered assaulting the patient), however I'm not sure..

What does your policy direct you to do? If you don't have a policy and there isn't plain evidence in sight (like a wristband, something written on a board, etc.) you need one.

Having said that, my impulse would be to start chest compressions while yelling my fool head off to bring someone who knows more about this patient than I do.

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When I worked in the hospital, every nurse on the floor was aware when a patient was a DNR. This was announced at the beginning of shift report so all were aware. This was pediatrics, however, so there was usually not more than 1, maybe 2, DNRs on the floor at any given time. And pediatric DNRs can be children actively dying vs chronic older kids/young adults whose parents have simply decided that they aren't going to put their child, who has already been through so much, through CPR or intubation if anything were to happen.

If the patient is a DNR and has no family at the bedside, you find him and start CPR and then 20 seconds later his nurse walks in and says "he's a DNR" and you stop, what harm has been done? If the patient is not a DNR and you find him and don't start CPR while you search for the nurse to find out if he's a DNR, you've lost valuable time by the time you find out he's not and go back to start CPR.

My floor also had code buttons at every bedside. It would literally be less than 10 seconds before every available nurse or doctor on the floor would be in the room when you hit the button. Many a parent found that out the hard way when they hit the "staff assist" button to ask for a towel and 30 people ran to their bedside.

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If you DO NOT KNOW IF THE PATIENT IS DNR, you start compressions while yelling for help on top of your lungs (or pressing that button, or doing whatever they use where you are). Whether it is "your" patient, or not.

You do not confirm anything. You do not search for anybody. You either know he is DNR, or jump onto chest. Plain, simple.

I am surprised one can work for 4 years without having that drilled into head ad nauseum.

Edited by KatieMI

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While you don't need a full handover on every patient do you not have a shift huddle where resuscitation status, unstable patients, falls risk, potential discharges and expected admissions are highlighted for everyone?

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Your facility doesn't use dnr bracelets?

Are you in the us?

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I am surprised one can work for 4 years without having that drilled into head ad nauseum.

OP already said she was embarrassed to ask so I think she has the same sentiment. Well she came to the right place to ask :)

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Thank you all for your feedback.

We don't use DNR bracelets on our unit. The code status is documented in the chart / kardex. We also don't have shift huddles where code status is discussed, as someone mentioned. We don't have code blue buttons in the rooms, either! We pull the call bell out of the socket in the case of a code, which are often (sadly) not responded to as quickly as one would hope. When the call bell is pulled out of the socket a nurse is expected to attend the room and help - if there is a code, they then call the code through the PA system.

Nurses are usually assigned the same patient for 1-2 days, then switched to a new set of patients. There are 5 patients for every nurse. As patient turnover is high and huddles are non-existent, we don't usually know anything about patients that are not assigned to us.

Thanks again for your help.

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