Code Procedures Please

tianaman · Mar 30, 2006

Hi guys, sorry in advance, but may I derail a bit. Can anyone please tell me what is LTC?

CapeCodMermaid, RN · Mar 30, 2006

Hi guys, sorry in advance, but may I derail a bit. Can anyone please tell me what is LTC?

LTC=Long Term Care!!!!

donmomofnine · Mar 31, 2006

No, we don't need to start CPR and residents and families know that when they come here!

tianaman · Apr 2, 2006

Really!!! I never imagined any health institution who will not initiatate CPR, I mean, I may be wrong, but isn;t it a MUST to at least try to save a life? CODE ok, maybe not all institutions can run it cause of lack of this and that, but simple CPR?????

donmomofnine · Apr 2, 2006

We really don't think of ourselves as a health institution, but rather as our resident's last home. We concentrate on making their time there as good as we can for them. We have compassionate and honest physicians who talk frankly with residents and families and we have a wonderful hospice provider that we use. We are part of a faith based community, so most of our residents and families are comfortable with death and dying. I really don't feel that CPR in this age group (all of our residents are elderly) is caring and compassionate most of the time. If a person requests that CPR be initiated at our facility, they can decide to go elsewhere. In my seven years here, that has never happened, or come back to bite us.

I guess I would be interested in hearing a story of CPR initiated in a long term care facility in a resident over 75 that was "successful" and how you would define a good outcome from doing CPR on this resident?

firstaiddave907 · Apr 3, 2006

All of the information above is totally on the money------however, my concern in LTC is that are we really updating, and checking whether a CPR status is appropriate for out residents. I'm a new DON (old nurse???) but was amazed to find that out of 60 some residents there were at least 15 "full code" residents??? CPR was never meant to jump start a 95 year old heart???? A little unrealistic I think. I've started re-evaluating all residents with the help of their physicians, families, social services, etc to get these records updated and explained. We recently had just this situation---with a CPR pt being found unresponsive, and obviously dead-------CNA's talked that he should have had CPR---(like they would know how to do it) and before it was done, we had state surveyors in the building on a complaint??? All has turned out well, and we do have new policies in the works. During this process I've learned alot, but DON's across the board need to be VERY INVOLVED in Advance directives----making sure they're updated------and knowing the laws in your state!!!!

I know how to do cpr i am cerfited in it and also in AED and i have my cna cerficate not to be rude or make u mad at all but some cna's out there are trained in cpr .

tianaman · Apr 3, 2006

We really don't think of ourselves as a health institution, but rather as our resident's last home. We concentrate on making their time there as good as we can for them. We have compassionate and honest physicians who talk frankly with residents and families and we have a wonderful hospice provider that we use. We are part of a faith based community, so most of our residents and families are comfortable with death and dying. I really don't feel that CPR in this age group (all of our residents are elderly) is caring and compassionate most of the time. If a person requests that CPR be initiated at our facility, they can decide to go elsewhere. In my seven years here, that has never happened, or come back to bite us.
I guess I would be interested in hearing a story of CPR initiated in a long term care facility in a resident over 75 that was "successful" and how you would define a good outcome from doing CPR on this resident?

uh huh, I see, sorry for my ignorance cause I really have limited or no idea of what an LTC is, is it the same as a home for the aged or something like that? so having your patients there, they are literally same as patients who are DNR, is the right? Please enlighten me and again sorry for my ignorance

donmomofnine · Apr 3, 2006

uh huh, I see, sorry for my ignorance cause I really have limited or no idea of what an LTC is, is it the same as a home for the aged or something like that? so having your patients there, they are literally same as patients who are DNR, is the right? Please enlighten me and again sorry for my ignorance

If someone wants life sustaining measures, we call the paramedics and get them out of the facility BEFORE they arrest.

Antikigirl, ASN, RN · Apr 4, 2006

One thing to remember first and foremost...equipment is needed yes, but your presence with the patient is utmost! Stay with the patient even if you have to yell between rescue breaths for help! Our facility had walkie talkies..those were a serious bonus!

Also, I will do CPR UNTIL I physically see the dated and signed copy of a DNR (ours are POLSTS, Physicians Orders for Life Sustaining Treatment). I can take a copy as long as it is dated and signed correctly! That doesn't mean I go off compressing and breathing...I do my ABC's first..usually that was enough time for a DNR order to make its way to me! The facility I use to work in had over 160 residents...so now they are in their rooms and checked frequently for any correction needed or to make sure they are still there!!!).

If I had to even get to the point of ABC...9-11 was called immediately! Even if I found a DNR a few seconds later...a DNR doesn't mean do not treat...so Paramedics can make that judgement call according to their protocols. They can perform comfort measures, like O2 or pain medications per protocol.

In the state of Oregon, any medic...either RN or CNA or LPN..anyone MUST perform CPR when necessary to the best of their training...it is the law. My advice...DOCUMENT like crazy after the patient is out of the facility or when you get a break point. Give what it was you saw as you entered the room in detail...your reason for performing treatments, what treatment, what happened, and so on! Your impressions of first scene are important...so details as you saw them (that way if someone wants to sue 7 years later, which is the term of limitations and common practice now...scary!, you have a detailed description of the event!).

And like I have said many times, if someone is not breathing and has no pulse they are dead, so anything you do (given no DNR) is a total bonus...so just do your best! Heck, God can bring back the dead...so it is pretty good if we mortals can .

tianaman · Apr 5, 2006

If someone wants life sustaining measures, we call the paramedics and get them out of the facility BEFORE they arrest.

but how about if you have an arrest before the paramedics come's in????

won't you even try to do CPR?? How about if the patient does not have a DNR form??? Isn't it illegal??

donmomofnine · Apr 5, 2006

No, we do not! Again, as I have said, residents and families know this when admitted. It is not illegal. We can select what residents we take and potential residents can select which long term care facility they want to live in!

Antikigirl, ASN, RN · Apr 7, 2006

If a facility claims it is a no code facility then it is NOT illegal! When they sign their concent and rental agreement that is in that agreement...so it is a assumed DNR.

That was put in place for care facilities that may not have 24 hour CPR care in their facilities.

For the place I once worked in...we had CPR and ACLS nurses 24/7 so we couldn't do that...so if they coded...we got it! All we could do is basic CPR and get those paramedics there! I only ONLY lost one, and I was ACLS! She sadly was found dead in the AM...so no telling how long she had been gone. I still, since she didn't have a DNR, proceeded with CPR slowly really...but considering she was stiff...well, I called the coroner instead of 9-11. That was my call as an RN.

The thing that really got me is that everyone I know wanted to know the correct procedure for codes. That one should be documented well in every facility!!! BUT..what about fire or natural emergency? We had NO plans for non moble patients on the second floor to excape or be helped!!!!!

I begged long and hard in my 4 years there to get that into motion...finally I got together with my CNA's and made a secret plan (lord knows if the administration found out they would have been mad!!!!!...."oh well that wasn't checked by the board!!!"....oh please!". So at least I know we have a makeshift plan for it!