Code Status- DNR After Resuscitation

[newnursemoon, ADN, RN]

OK well this shift was a doozy. So at 1835, another nurse called a code on my pt. She had been medically cleared for discharge for about 5 days, pt was pending placement at skilled nursing home. She was brought back quickly, but when I called the LAP, he thanked me and said he would call his family. Not 5 min later he calls back and says, “my wife reminded me- she’s a DNR.” I confirmed on the chart, no DNR forms were present. Pt son asked what the options were, so the ICU MD explained from there.

I feel so many emotions right now, this is the first time I’ve had a pt code on me. I’m honestly not even sure what happened to cause the code- she was a medically cleared! I wrote up my forms and informed the charge and nurse manager but man. This was a crazy one. 

[MunoRN, RN]

This is sort of thing that is highly dependent on the particular nurse caring for the patient after this sort incident.

Many if not most nurses might just say, 'oh well, no harm done', although others and quite possible myself would, and have in similar situations, reported the MD for criminal assault.  

This is not just a simple oversight, this is a grossly negligent failure of the LIP to correctly identify what physically invasive procedures the patient would want given cardiac arrest.  Anyone who knowingly violates that, either by ignoring the life sustaining orders present or failing to properly communicate that they have declined such interventions is guilty of a very serious crime, we shouldn't ignore that.

[newnursemoon, ADN, RN]

3 hours ago, MunoRN said:

This is sort of thing that is highly dependent on the particular nurse caring for the patient after this sort incident.

Many if not most nurses might just say, 'oh well, no harm done', although others and quite possible myself would, and have in similar situations, reported the MD for criminal assault.  

This is not just a simple oversight, this is a grossly negligent failure of the LIP to correctly identify what physically invasive procedures the patient would want given cardiac arrest.  Anyone who knowingly violates that, either by ignoring the life sustaining orders present or failing to properly communicate that they have declined such interventions is guilty of a very serious crime, we shouldn't ignore that.

You’re exactly right. I reported the incident and the MD, the hospital supervisor is weighing options now. This wasn’t OK and I’m riddled with anxiety and guilt. 

[Okami_CCRN, BSN, RN]

On 6/25/2022 at 8:26 PM, newnursemoon said:

5 min later he calls back and says “my wife reminded me- she’s a DNR.” I confirmed on the chart, no DNR forms were present. 

I'm a bit confused regarding this statement; you checked the chart and confirmed there were was not a DNR form, or you checked the chart and it was flagged as DNR, but did not contain the appropriate form?

 

[newnursemoon, ADN, RN]

7 minutes ago, Okami_CCRN said:

I'm a bit confused regarding this statement; you checked the chart and confirmed there were was not a DNR form, or you checked the chart and it was flagged as DNR, but did not contain the appropriate form?

 

No form present at all. Chart wasn’t flagged, nothing listed this pt as DNR

[Okami_CCRN, BSN, RN]

12 minutes ago, newnursemoon said:

No form present at all. Chart wasn’t flagged, nothing listed this pt as DNR

Thank you for the clarification; based on that answer then the code blue was called appropriately. 

It is so important that as nurses we have a goals of care/advance directive/healthcare wishes discussion on admission and if a patient identifies themselves as a DNR/AND that we notify the LIP so that the correct code status can be placed on their chart. 

[Tweety, BSN, RN]

I'm a bit confused.

What does LAP mean?

Also, did the doctor's wife remind him the patient is a DNR or did the son call you back and say it was his wife.  

[newnursemoon, ADN, RN]

4 minutes ago, Tweety said:

I'm a bit confused.

What does LAP mean?

Also, did the doctor's wife remind him the patient is a DNR or did the son call you back and say it was his wife.  

Lap is legally authorized person, so someone who makes the decisions when the pt can’t. 
the son said the wife reminded him that the pt is a DNR. 

[Tweety, BSN, RN]

4 minutes ago, newnursemoon said:

Lap is legally authorized person, so someone who makes the decisions when the pt can’t. 
the son said the wife reminded him that the pt is a DNR. 

Gotcha.  Well if the legally authorized person didn't know she was a DNR one can't blame the staff or even the MD for not being told this.  Maybe the MD could have pried further or asked when admitting the patient.  But too bad the LAP didn't make that clear from the get go either.

[JKL33]

On 6/27/2022 at 7:21 PM, Tweety said:

Maybe the MD could have pried further or asked when admitting the patient.

It sure seems like one of those issues where it's simple, you just push until you get some kind of answer. But..we don't know that the provider didn't at least ask.

I'd think a legally authorized person ought to be able to come up with that info without being reminded by someone else. Maybe it isn't the first time that guy hasn't known which end is up.

On 6/25/2022 at 8:26 PM, newnursemoon said:

I feel so many emotions right now, this is the first time I’ve had a pt code on me. I’m honestly not even sure what happened to cause the code- she was a medically cleared!

What kind of a code was this that she was brought back easily from? What intervention was required?

[Tweety, BSN, RN]

9 hours ago, JKL33 said:

It sure seems like one of those issues where it's simple, you just push until you get some kind of answer. But..we don't know that the provider didn't at least ask.

Right, it is unknown whether the provider even asked.  

Does "legally authorized person" mean they have power of attorney and are the health care surrogate (terms we use here in Florida) for all decisions?  

My parents are 85 and 88 and I am in their living will as their health care surrogate should they not be able to make decisions for themselves.  But that isn't the case yet.  So when they go in the hospital it's them, not me, to decide their code status.  So maybe in this case and the patient was asked if she was alert and oriented?

[newnursemoon, ADN, RN]

On 6/27/2022 at 8:29 PM, JKL33 said:

It sure seems like one of those issues where it's simple, you just push until you get some kind of answer. But..we don't know that the provider didn't at least ask.

I'd think a legally authorized person ought to be able to come up with that info without being reminded by someone else. Maybe it isn't the first time that guy hasn't known which end is up.

What kind of a code was this that she was brought back easily from? What intervention was required?

Asystole. Chest compressions intubation, somehow she came back in 25 min