not coding a non dnr patient

chocokitten · Nov 25, 2007

... yeah, sounds like a legal suit waiting to happen... scary

TazziRN, RN · Nov 25, 2007

I have never not coded a pt but I have participated in slow codes.

allnurses Guide · Nov 25, 2007

Have any of you ever had a patient who wasn't DNR and was not coded?
Let me tell you the story behind this question. I just recently graduated and I work in the NICU. The baby was about 5 months old, just got a trach done and basically had many issues & was never going to have a normal life. We all thought the patient should be DNR but the parents wanted everything done. It seemed like the pt was getting a litte bit better after the trach but then a few days ago (I wasn't there that day and neither was his primary doctor) she started going down hill all day long to the point where her heart rate and sats dropped and they were bagging her with no response. The doctor on call that day instead of starting a code came in and said that it looks like this is it for her and nothing else was done & I guess no one spoke up.
Now what do you guys think? One part of me knows it was for the better and if it was up to me I wouldn't want to code her but it wasn't our decision. The parents wanted everything done and I know her primary doctor did as well (he referred to her as his daughter and before he left the day before he told her that "dr..... loves you"). So now the two doctors are going to probably have a big falling out once her primary finds out nothing was done. And what about the parents, I'm sure the hospital can get in a lot of legal trouble, right?

I know it is different for us in the UK but personally I think that as long as the doctor who made the decision had all the facts about the case and made the not for resus decision based on these facts this is a reasonable judgment to make. THe comment that her doctor referred to her as his daugher and told her dr loves her has me concerned it sounds as if his personal feelings were affecting his clinical judgement, not wanting to sound heartless but as you have said in your post as her nurse you felt she should be DNR, surely the doctor should have been giving the parents realisitic information about the survivability of thier daughter and helping them come to terms with the inevitable rather than getting attached and giving false hope.

ukstudent · Nov 25, 2007

In some States it is legal for the Doctor to make a pt DNR without the next of kin's approval. Where I, the doc would have been in the right if he/she thought that the effort would have been futile.

Jolie, BSN · Nov 25, 2007

Keep in mind that in infants, most codes are related to respiratory failure. You state that the baby's heart rate and sats continued to drop all day long, despite bagging, which was probably the most effective way to address her respiratory failure. I think that the physician made (an accurate) assessment that her lungs were incapable of supporting her body's needs, and that pumping her full of meds, and torturing her with chest compressions and other procedures was pointless and cruel. In my mind, bagging her amounted to coding her, and it wasn't effective.

My deepest sympathies to everyone.

caliotter3 · Nov 25, 2007

I took care of an adult who lived in the parent's home whose medical records indicated what the code status was. I was told by one of the nurses who had been on the case for a long time, that once she was prevented by both of the parents from taking appropriate action when the client was having problems. I informed my supervisors about the situation and was told that I was to follow the instructions given in the medical record and that they would reinforce with the parents, the situation, and try to get them to change the code status if that was their wish. However, I found out that this family was known for their lawsuits concerning the patient. I was glad when I ultimately got out of there.

allnurses Guide · Nov 25, 2007

In some States it is legal for the Doctor to make a pt DNR without the next of kin's approval. Where I, the doc would have been in the right if he/she thought that the effort would have been futile.

This is where it is really different in the UK, over here we make the judgment then discuss it with the family but legally it is the decision of the medical team and not the family. We have no legal need to ask consent

lsyorke, RN · Nov 25, 2007

she started going down hill all day long to the point where her heart rate and sats dropped and they were bagging her with no response.

This would be coding her. What else could be done if the respiratory support wasn't working? If she was unable to support oxygenation even with manual ventilation, there's really not much sense in doing anything else. Keeping her heart going with drugs wasn't going to change the lack of oxygenation.

cmo421 · Nov 25, 2007

Sounds like she was mini coded all day. If the doc that said stop was there all day ,and knew what had happened and what was done, he can say stop. As long as the charting has been kept up on everyone's part,even if it goes to court, I doubt they will win. Now I wonder how the family will find out exactly what happened at the end? Did the doc there speak with them before and after? Lots of facts left out that may influence reaction.

Conrad283, BSN, RN · Nov 25, 2007

There is such thing as a pharmacoligical code where the MD's pump them full of meds, so I guess there's such thing as a non-pharmacoligical code. The MD's are smart and I suppose that he knew that the baby was not going to make it regardless of treatment.

At first I thought that what happened was wrong, but after reading some of the other posts, I suppose they did the correct thing.

Lorie P. · Nov 25, 2007

she started going down hill all day long to the point where her heart rate and sats dropped and they were bagging her with no response. the doctor on call that day instead of starting a code came in and said that it looks like this is it for her and nothing else was done & i guess no one spoke up.

sounds like she was being coded and it was not working. had this on-call doc been in and out of the nicu all day?. if so then he knew nothing was going to help with these baby's respiratory distress. even the trach didn't help at all, she seems like she was one that everything had been done and nothing was working.

i am so sorry for the lose.