Coding visitors?

[blondy2061h]

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?

[bjaeram]

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.

So you would just stand there and do nothing??? What difference does it make if it's a child or adult. You need to do at least BLS.

[bjaeram]

At our facility staff would start CPR, throw them on a cart, and run like hell to the ER, dump them off and go back to there organized world.

The ER is used to coding and treating people they know nothing about. Just follow the ABC's and you are good. What's the worst that will happen if you give them something they are allergic to? THey are already dead! They will be on a vent, we can give benedryl. Really worrying about allergies is a low priority. A name is not so important. We John Doe people all the time. THey are entered in the system that way and we can do labs ect under that name. Eventually they are matched to the real name when we learn it. Past medical hx would be helpful but not all that necessary either. By the way you have the wife 2 feet away.....ask her for the details! Check the wallet or cell phone on others.

[elkpark]

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.

I'm curious -- what would be the rationale for tiptoeing around an adult and leaving them dead, but doing something for a child???

I agree that the best choice is to know and follow your facility's policy. Everywhere that I've ever worked, the expectation has been that we would respond to a "down" visitor/coworker/whatever the same as we would to a client -- presume full code, presume consent, respond medically as indicated by the situation. Everywhere I've ever worked, the presumption is that if someone is in an emergency situation on the property, we do have the same legal duty to that person that we do to any of the registered clients.

I would guess that a facility (and individual employees) could end up in a lot more trouble for not coding someone found unresponsive than you ever could for responding appropriately.

[ChristineN, BSN, RN]

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.

I don't understand this attitude. As a nurse, if a family member/visitor/staff member went down at work, I could not just "wait" for code team or EMS to arrive. As a nurse, I can initiate CPR, give O2, etc that could mean the difference between life and death.

[blondy2061h, MSN, RN]

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.

Thank you! Almost every thread here could be answered by saying "check your facility's policies." There's nothing wrong with discussing it and hearing other people's experiences, still.

[sissiesmama, ASN, RN]

I have had this happen on a few occasions. A grandma staying at grandson's bed coded in the hall after she left the patient's bedside on a med surg unit. We coded g ma and sent her to the ER and to ICU.

The second time, I was working in the ER and heard someone screaming for help, and I was the closest person to the ER doors. Apparently a patient's family coded on the floor, and no one knew what to do, or panicked, or whatever, and they got a w/c and just pushed her from the 6th floor to the ER. Let's just say she was a REALLY pretty shade of blue once she got in the doors.

These family members that crash, at least at our facility, we admit for the code as "Jane Doe" or "John Doe" to get everything started.

Anne, RNC

[3rdcareerRN]

... but it got me thinking...

Kudos for thinking! What I like to see nurses here and at work do is recognize what might happen, because then they can plan a better response than whatever their immediate reaction would be.

Spending an hour looking at the policy manual exposes you to lots of things that might happen, and how you should react. I had a nursing school instructor who told me to imagine the worst that could happen to my patient or family, and plan what I would do. I've found that to be useful advice. Also I find these forums hugely useful to enlarge my imagination of such things, which I hope makes me a more prepared and better nurse.

(yes, I'm a former Boy Scout -- the motto was "Be prepared.")

We're all in this together, so let's support each other in becoming better.

[RNforLongTime]

If any visitor is found down, we are to call the nursing supervisor and have that person transported to the ED.

[Flare, ASN, BSN]

I had this situation last week at my hospital job. Was going up to a floor to talk to a patient that wanted to sign out AMA and in the meantime his friend picking him up stopped breathing.

We lifted him out of the chair he was sitting in and put him on the patient's bed. Fortunately I could feel a pulse and after a little bagging and a sternal rub as wh wheeled him to the ER he came back to us, but I wonder what his fate could have been had the patient taken longer in the bathroom.

[NicuGal, MSN, RN]

You have to call a code for visitors too. We hate when that happens in our unit because if you are over 10 pounds, you are out of our league except for CPR. We joke that we would like to drag them by their feet out to the hall and run lol Of course we wouldn't do that! lol

We had one mom go down and she was out. She fell off of a stool onto the floor, hit her head (she was also a brittle diabetic) we were like, oh crap! Called the code and we were all standing their open mouthed when they cut her clothes off, thru in a line and ran off with her on a cart....our codes aren't like that!!!l Now we joke, if I keel over don't let them cut my clothes off in the middle of the unit lol

[BluegrassRN]

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").

Just like how a lot of people arrive in the ED: no history, no info, no knowledge of code status. You assume consent until you find out otherwise. You code just like you would anyone else.

[psu_213, BSN, RN]

If any visitor is found down, we are to call the nursing supervisor and have that person transported to the ED.

I'm hoping you do more than that, i.e. start with at least BLS. To me, it seems like calling the nursing supervisor is no the best way to get fast results (speaking from experience).