Coding visitors?

[blondy2061h, MSN, RN]

I had a patient last night who was well over 80. She was a DNR. Her husband, also well over 80, was spending the night. I went into the room to hang an IV med and there he was. And he looked dead. I stood watching him for like a solid 30 seconds, and he didn't appear to be breathing. When I went closed to him it became apparent that he was breathing. But he seriously looked dead for a second there, lying perfectly still, gray, and with a solidly positive "o sign."

Obviously I was glad he wasn't dead, but it got me thinking- what if he had been?

[bill4745, RN]

You would call a code, just as you would for a full-code patient.

[blondy2061h, MSN, RN]

I figured that would be the case, but I'm thinking more of the logistics of it. We'd have no past medical history, no allergy info available, and no age or weight. We'd be coding him in what, the little visitor chair? On the floor? As a non-registered patient I'm not sure how we would get labs on him or anything. We wouldn't know his code status, though as you said, it would obviously need to be presumed to be a full code. What about liability for the hospital? He'd have no consent to treat (though legally assumable, I presume "implied consent"). What if he had been there hours and just noticed as dead? Would we be liable there, even though he was not a patient, as nurses had been walking past him literally all night?

Just curious. Hope I never actually live out this situation.

[casi, ASN, RN]

We are supposed to call code blues on visitors. We also have a "code 9" for visitors which are medical emergencies inside the building that isn't a code blue or pink(baby) and any medical emergency on facility grounds or in the parking lot.

[clemmm78, RN]

We had this situation when a patient was attending cardio clinic (she was post MI). Her husband had a full arrest in the waiting room. He ended up in our ICU for three weeks, but he walked out of there. Talk about being in the right place at the right time!

[talaxandra]

At my hospital we call a code on any non-inpatient that collapses or otherwise needs urgent medical attention on the grounds - ED staff and the med reg respond, and they make decisions about intervention and treatment, just as they would in the department. Obviously any pertinent information is helpful, but not essential.

[ChristineN, BSN, RN]

I had this happen to me as a new grad. I was working peds and my pt's grandma, who was sole guardian, was staying with pt round the clock in the hospital. Long story short, grandma was neglecting her care to take care of her grandchild. Grandma was not taking ANY of her meds, including diabetic meds and BP meds. When the grandma was informed she was losing custody, grandma ended up having anxiety and panicing, which led to a grand mal seizure. Grandma was sitting up in the bedside chair when we coded her, not ideal at all. I remember that the doctor's kept screaming at me for a medical history, as if I would know (just cause I'm the pt's nurse doesn't mean I know about the whole family).

[simboka]

This actually happened just last week on our floor. Pt just got to floor from ED, husband was found down and blue, called a code, and our nurses made a save (Go team!). But anyway, our policy for visitors or staff if they're having issues is that a code gets called, for whatever the medical emergency is. It was on dayshift, so I didn't see the logistics of how they took care of things, or got them down to the ED or what.

But you're right, there is an issue with have no information on them, but you make do with what you got, right? Implied consent, full code until proven otherwise, probably get a generic STAT name until things get sorted out.

[fiveofpeep]

we call a code for any visitor medical issue and then send them off to ED

[Spacklehead, MSN, NP]

We'd have no past medical history, no allergy info available, and no age or weight. We'd be coding him in what, the little visitor chair? On the floor? As a non-registered patient I'm not sure how we would get labs on him or anything. We wouldn't know his code status, though as you said, it would obviously need to be presumed to be a full code. What about liability for the hospital? He'd have no consent to treat (though legally assumable, I presume "implied consent").

Many times this is what the ED staff have to deal with if a person is found down in public somewhere unattended and brought in - there is no info available, patient is unresponsive. You just have to follow ACLS protocols. As far as labeling labs, in the ED we would typically check for a wallet (if EMS didn't find one already) to see if there is a driver's license that at least could give us a name and DOB. I do believe one time we used the name "John Doe" (for labs/meds) for a male pt. until we were able to get info. In the case of emergent, life-saving treatment where a patient codes - we did not need consent to treat in the ED; even a minor brought in for a code situation would get life-saving measures without parental consent if no parent was immediately available. Obviously once a family member could be contacted, consent would then be obtained.

[SharonH, RN]

I figured that would be the case, but I'm thinking more of the logistics of it. We'd have no past medical history, no allergy info available, and no age or weight. We'd be coding him in what, the little visitor chair? On the floor? As a non-registered patient I'm not sure how we would get labs on him or anything. We wouldn't know his code status, though as you said, it would obviously need to be presumed to be a full code. What about liability for the hospital? He'd have no consent to treat (though legally assumable, I presume "implied consent"). What if he had been there hours and just noticed as dead? Would we be liable there, even though he was not a patient, as nurses had been walking past him literally all night?

Just curious. Hope I never actually live out this situation.

Well what are your options? Leave them there, dead? Regardless of the logistics, medical history or not, with or without the consent to treat, you really have no choice. Code them. And like you, let's hope we never run into that situation.

[Altra, BSN, RN]

Four words:

A

C

L

S

Actually, as a nurse employed by a hospital, you have been trained in at least BLS, which teaches both clinical and non-clinical staff everything they need to know to respond immediately to exactly that situation: check for responsiveness, call for help, initiate CPR, etc.