Code Status of a Conserved Patient

[bluejeanjunkie]

Thank you for reading this question.

I have a patient at a nursing home who was admitted Sunday afternoon wherein I cannot contact her conservator regarding her code status. I just left a voicemail. The H & P from hospital states that she is a DNR, but regardless there was no document from the conservator that states her code status. Suddenly, the MD came in to do admission visit for the resident and puts a written order- Code Status "DNR". I do think that this is still not DNR, until a document from the Conservator shows that the patient is an actual DNR? Correct?

Now what if it's sunday (and unable to contact the conservator), the patient's heart stops beating, is she still a full code?

There is a grandson on file, but the pt is conserved....

Please let me know.

And I am from California.

[classicdame, MSN, EdD]

depends on the laws in your state. Better talk to a social worker or case manager if you are not sure. It may be possible for the MD to over-ride the conservator's wishes and it may be the MD did not consult the conservator. Until the issue is rectified I would treat as full code - but, again, that may depend on the laws in your state.

[shiccy]

Don't really understand what "conserved" is (in relation to pt status). I will say that I've had people "DNR-CC" (Comfort Care only) or DNR-CCA (Comfort Care, but do everything except compressions/intubation) per MD order only r/t pt wishes.

An idea you could try is to contact the nephew and see if HE can't get ahold of the person you are trying to reach. Other than that I suggest to keep trying!

I've asked this question myself before, and have been told "that would be a slow code". When asked what this is they say, "I wouldn't exert myself and rush like I would in a real code, and take a few extra moments going down to the room." Not that I'm ADVOCATING for something along these lines, but ....

[Morning-glory]

Doctors are usually very hesitant to write DNR orders. I have had huge battles on this issue with the doctors and the Public Guardian and Trustee of the residents. What it comes down to, is that the PG&T will not authorize a DNR ever. The doctor must make the determination that it would be "medically futile" and then order the DNR. Check the charting to see if any of this is in the progress notes. At least here, the PG&T is not allowed to make the DRN call. It is up to the Doctor to evaluate the person and determine if there is grounds for it. They don't like to do it, so if they do, it is a huge battle won. Even if a person has a guardian, we need to get the DNR from the NOK if there is one.

Good luck and let us know what happens.

[KaroSnowQueen, RN]

I would ask your social worker to call the hospital's medical records and see if there is a copy of the DNR there signed by the conservator. If not, she needs to call the conservator and get one sent to your facilty and put in the chart.

If it were me, and you didn't have this from the conservator, I would go to the DON, and get her opinion. And I would chart it in the chart to CYA. "Discussed pt's DNR status with DON, who stated we should go by MD's DNR order in chart." Or something to that effect.

[brillohead, ADN, RN]

Don't really understand what "conserved" is (in relation to pt status). I will say that I've had people "DNR-CC" (Comfort Care only) or DNR-CCA (Comfort Care, but do everything except compressions/intubation) per MD order only r/t pt wishes.

I think what they're meaning to say is that the patient has a legal guardian responsible for their medical care.

A conservator is someone who takes care of the finances/assets of a person who is mentally and/or physically unable to take care of it themselves, and a guardian is someone who is in charge of the care of the person physically -- food, shelter, clothing, medical care, etc.