Coding visitors?

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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?

Specializes in chemical dependency detox/psych.

Additionally, if they are in a chair, we get them down to the floor--can't do compressions with them sitting up. :p

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Specializes in ER, education, mgmt.

I can tell you one thing not to do. That is call 911. What are the medics going to do? Put them on a stretcher and take them 2 floors down to the ED? Plus, EMS may want to take them to another facility and that would be a big no-no for you. Actually, per EMTALA guidelines (and all hospital personnel are required to abide by them, not just ED) emergency and stabilizing treatment must be provided. This includes anywhere within 250 yards (yes, yards) of the medical center (with some exceptions). And this standard holds regardless of the size or capabilities of your facility.

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Specializes in OR, peds, PALS, ICU, camp, school.

Depends on hospital policy- we prefer in my hospital that you do not call a code blue- we have a code just for visitors or out patients whether they're in arrest or just faint. The ER sends a team (vs the ICU based team that responds to codes) that includes medical and nursing staff as well as a registrar. The registrar is the key- gets the person entered quicky to be able to send labs and access any history or med rec we might have if the person has ever been treated in network. Obviously, if a code is called, the ICU responds and pitches in but we lose that piece.

As for the chair? Well, what do you do if your pt's in the chair when they code (or the commode!) Just ease them to the floor. Push what you can out of the way. The usual.

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Specializes in Critical Care.

Instead of posting here for opinions, you need to look at your facilities POLICY. All facilities I've worked at have a policy for just such an incident and how to handle it. In my present facility, you do call a code but tell the operator it's a visitor and the appropriate response people are paged out. You as the nurse who found the patient act as a first responder which would entail using BLS till the code team arrives. The resusitation continues as the visitor is transported down to the ER where they are usually placed in a trauma bay and appropriate treatment is administered.

It's always nice to seek out peer support in an environment like this one, to compare what peers are doing at other facilities. But you need to be very familiar with YOUR facility's policies as those are the ones that will protect your practice. And of course you should know your state's practice act. Never hurts to look up good samitarian laws either in case you decide to help someone in a public setting.

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Specializes in Critical Care.
I can tell you one thing not to do. That is call 911. What are the medics going to do? Put them on a stretcher and take them 2 floors down to the ED? Plus, EMS may want to take them to another facility and that would be a big no-no for you. Actually, per EMTALA guidelines (and all hospital personnel are required to abide by them, not just ED) emergency and stabilizing treatment must be provided. This includes anywhere within 250 yards (yes, yards) of the medical center (with some exceptions). And this standard holds regardless of the size or capabilities of your facility.

Making blanket statements like this aren't always a good idea. In some facilities, dialing 911 INSIDE the hospital (not accessing an outside line) is how the code team is activated. And yes, many facilities have the patient transported to the ER for treatment but it's by the internal staff which may include in-house paramedics as well as interns, respiratory, resident MD's and critical care nurses.

Hardest resuscitation I've ever assisted in was a visitor found down in the bathroom near the parking structure of the facility I was at. Those staff who responded were awesome, one of the best run codes I've ever seen. The key is to be familiar with everyone's role and how they interact. This patient was transported with resuscitation continuing as they went to the ER.

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Specializes in LTC.

I guess in a hospital setting it would be different but I work in ltc so I personally wouldn't code a visitor unless it was a child because we woulnt have a legal responsibility for a visitor . I would call 911 though . we might be covered under the good samaritan law nut Iyself still wouldn't risk it in my setting.

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Specializes in Oncology.

Of course I realize that I need to look at policy. I am interested in others' experiences though. So far my hospital would be different from anything mentioned here, as we do not have an ED.

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Specializes in Critical Care.
Of course I realize that I need to look at policy. I am interested in others' experiences though. So far my hospital would be different from anything mentioned here, as we do not have an ED.

If you realize you need to know your facility's policy, what type of information are you seeking here? If you don't have an ER at your facility, I'm quite sure they do have a mechanism in place to deal with such situations.

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If you realize you need to know your facility's policy, what type of information are you seeking here? If you don't have an ER at your facility, I'm quite sure they do have a mechanism in place to deal with such situations.

To stimulate discussion?

I, for one, have found this thread very interesting. There were complaints not too long ago about having the same types of posts repeatedly. I would think that this would qualify as a good discussion on the board about various policies and what experiences we have had with non-patients coding.

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

i've actually coded visitors a couple of times. first one got off the elevator and collapsed -- we had no idea who he was or who he was planning to visit. we were doing cpr in the hallway when his wife ambulated past . . . uh0h. big scene. didn't save the guy, either.

the second was after my manager foolishly gave 10 mg. of im valium to a visitor (after i refused to) because she was "so upset" at the loss of her father. she quit breathing. we bagged her all the way to the ed.

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Specializes in ER.

Working in the ED, we have pt's brought in by EMS coding, we don't know anything about the situation, no med hx, no nothing..we just get them on the stretcher and do what we gotta do. We put an arm band on them that says , "ER MALE or FEMALE" till we can find out their real name, and sometimes we don't. If you're patients husband had been sitting there dead for hours, I don't think you would be held liable...even though they would probably question how could you not tell he was dead and maybe question your assessment skills, even though he was not ur pt to assess...i just don't think u would not know if someone was dead that's all lol...you thought this guy was dead..i'm sure you would have gone up to him and touched him or something..u wouldnt have let it go.

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This might be a good time to remember all who have medical conditions, on meds-carry an updated list-my suggestion is with to or next to wallet....things can happen to anyone!

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