Code status and end of life should be nursing decisions.

[Woodenpug, BSN]

O.K. another cold code. I don't want to make a long post about something we have all experienced.

Nursing is the human response to health and health conditions. Would it not be more appropriate if we were equally important to determining the patient's code status as is the MD? If for no other reason than that nursing is collaborative and we would be concerned about the patient.

Under ideal circumstances survival to discharge for a code is roughly 1 in 100. Modified codes are less than ideal circumstances.

The patient is informed that to be intubated means a life on the respirator and consequently decides, with the MD, that a modified code is appropriate. How often does the patient know that the possibility for survival to discharge, after a code, without a protected airway is zero? The MD is preforming outside his expertise in assuming that the patient's response to the health condition would be to prefer no intubation without the possibility of d/c. The MD lacks the tools necessary to make an appropriate nursing diagnosis.

[VegRN]

I do agree that doctors often don't fully explain code status but I don't think it should be up to nursing to decide code status. Really it should be up to the pt to decide code status! The doctor does need to fully explain what happens during a code, the actual chances that they would make it out of a code and what kind of quality of life they are likely to have after. I agree doctors aren't doing enough of this and I really wish it would change.

[Blee O'Myacin, BSN, RN]

I do agree that doctors often don't fully explain code status but I don't think it should be up to nursing to decide code status. Really it should be up to the pt to decide code status! The doctor does need to fully explain what happens during a code, the actual chances that they would make it out of a code and what kind of quality of life they are likely to have after. I agree doctors aren't doing enough of this and I really wish it would change.

When I worked the ICU and even now when we have critical patients, I'd go through all the equipment and drips and describe what each one does. "This is the ET tube. Your mother is not able to talk to us because it goes in between the vocal cords and sits in the main stem of the brochial tubes, delivering air to the lungs through the ventilator..." etc. I was always direct and forthcoming with information. "We are giving IV potassium, magnesium, calcuim and sodium bicarbe because..."

I think that nurses can play a vital role in helping a family decide what to do (or not do) for a critically ill family member by acting as an educator of the family and an advocate for the patient.

When my father was vented in the ICU, I wish that the staff was as forthcoming with information. I think that in his situation, comfort care would have been ideal. Instead, he died on the vent, on four pressors, CVVHDF and a trach. He had a DNR/DNI, but coded in the OR and was "brought back" for three weeks of torture. Knowing then what I know now would have made a lot of difference to those of us who loved him.

Blee

[XB9S, BSN, MSN, EdD, RN, APN]

This is something that was discussed in the UK last year and guidence issued by both nursing and medical professional bodies

Experienced nurses should have the authority to decide if patients should be resuscitated, according to new guidelines to health professionals. Until now only consultants and GPs were allowed to decide on resuscitation.

The guidelines were issued by the British Medical Association (BMA), the Royal College of Nursing and the Resuscitation Council.

The Patients Association welcomed the move, saying nurses were better placed than doctors to know patients' wishes.

http://news.bbc.co.uk/1/hi/uk/7065010.stm

[bollweevil]

Why would a doctor need to make a nursing diagnosis?

Why would a nurse want to be responsible for determining who gets coded and who doesn't? Or to what degree? Each patient and/or the patient's closest loved one should make this decision, ideally.

In the past, it was normal for the patient's doctor to know the patient best, having had a relationship with said patient for some time. Now, the doctor is often a new acquaintance, an intensivist, who doesn't know the patient or the family any better than the nurses, who are caring for the pt for the first time. Or maybe the nurses have known the patient for a while, if pt is chronic. It's a whole new ball game. Still, the responsibility of deciding such a major issue should be left to the one(s) most affected by it, namely the patient and his spouse or children, maybe with help from their clergyman.

[loriangel14, RN]

Where I work code status is strictly a pt or POA decision made with information from nursing or their doctor.

[Batman24]

Where I work code status is strictly a pt or POA decision made with information from nursing or their doctor.

That's how I think it should be.

[Woodenpug, BSN]

I think that is what I'm saying. If it was a nursing decision, it would be the patient's informed decision. That's how we do stuff, in collaboration. Medicine makes a decision then informs the patient. In code status the MD decides a patient is no code, then informs the patient by suggesting that the patient should be on a modified code. Don't you believe that nursing would use a different approach?

MD's make nursing diagnoses, albeit poorly, on a frequent basis. Code status is only one example.

[loriangel14, RN]

In code status the MD decides a patient is no code, then informs the patient.....

Where I am from the doc has NOT got the power to DECIDE the pt is no code. This is pt or POA decision.

[TiredMD]

Where I am from the doc has NOT got the power to DECIDE the pt is no code. This is pt or POA decision.

Actually, physicians can make a patient no code, if they judge that any further intervention would be medically futile. Physicians are under no obligation to offer care that they do not believe would provide benefit to the patient. This can include intubation, resuscitation, etc, and it does not require the consent of the family or patient.

Obviously this is rarely done, but it does come up from time to time.

[CHATSDALE]

i don't believe that a md should have the final say-so in a code situation, this is the life on the patient and it will affect the family long after it has been forgotton by md or nurse

there was a lawsuit about this concerning a child who was on a respirator and the family could not bring themselves to take him off the machine

the hospital tried to get a judgement from the court, witht he doctor testifying that the boy was brain dead

there was talk in the nurses station about the organs not be harvestable after so long a time

the judge agreed with the family and the boy died a couple of weeks later

i don't know what i wuld have done in that situation but i don't want someone else deciding by fate except my family

[sharona97, BSN, RN]

I think that is what I'm saying. If it was a nursing decision, it would be the patient's informed decision. That's how we do stuff, in collaboration. Medicine makes a decision then informs the patient. In code status the MD decides a patient is no code, then informs the patient by suggesting that the patient should be on a modified code. Don't you believe that nursing would use a different approach?

MD's make nursing diagnoses, albeit poorly, on a frequent basis. Code status is only one example.

Remember patient rights? I think it's called a health care directive. If none than the family needs to make an obviously painful decision. They are family, and IMO we are the caregivers.