CPR in LTC

[pretty70]

Hi. I have been working in an Alzheimer Unit for almost 5 years and I have never performed CPR because of the Advance Directives. Lately, we have been getting new admissions psychiatric younger patients but very sick and full code. Please can you share your experiences with me performing CPR in LTC . Also, we only have 1 AED in the facility of 140 residents is this normal? Thanks in advance.

[WhiteScrubs]

Mock codes in LTC would be a fantastic idea... where I worked we had a significant # of short term post-op patients there for rehab that were nearly all full code. It was rare, but we did get the occasional code. Because it was so rare, everyone freaked out, no one knew what to do.

After hours, no MDs on site to run a code -- just CPR and AED as needed until EMS arrives, and only the nurses in the facility are trained in BLS (CNAs are not required to be certified, which I will never understand.) So in order to get enough people who know what they are doing, pretty much all nurses are pulled from every unit of the building, and are frantically trying to find back boards, portable oxygen, BVMs, while security brings the AED.

Fire drills are a regular occurence, though we'd never had a fire. Code drills never happened, though we did get the occasional code. Who knows... If I'm ever back in contact with that facility, I might suggest that to management.

Thanks!

[Spritenurse1210, BSN, RN]

When ever you start a new job anywhere, always ask (if it hadn't been told to you during general or nursing orientation):

1. Where is the crash cart(s)

2. Where are the fire extinguishers/emergency exits/facility disaster manual (READ WHAT YOUR ROLE WILL BE.)

Make sure you write these down and memorize where these items are, as well as what your role will be. Many LTC centers only have one nurse during the night; and a couple during the day per wing.

My first code as a nurse was in a LTC center on my first day of orientation. The patient didn't have a clearly defined POST form, or Advanced directives. He went bad shortly after arriving and had to be sent out CPR in progress. I doubt seriously he made it. Moral of the story: Make sure you know who your DNRs are and see to it that they have documentation in the chart. Just because you are in LTC doesn't mean you won't have to code someone. Good luck to you

[CapeCodMermaid, RN]

In Massachusetts, we MUST have an AED in our facility. I've participated in more than a few codes in LTC and it's pretty basic. We are allowed to give meds IV push so we really just call EMS and start CPR. We run a few mock codes during the year to make sure everyone knows what to do. I usually volunteer to be the patient.

It was only last year in this state that the DPH clarified its position on doing CPR. We no longer have to do CPR on a decapitated person even if they were listed as a full code!! Gee, thanks!

[SuesquatchRN, BSN, RN]

It was only last year in this state that the DPH clarified its position on doing CPR. We no longer have to do CPR on a decapitated person even if they were listed as a full code!! Gee, thanks!

[RescueNinja]

This may have been said already (sorry I didn't read previous posts), but when I did my consolidation in ICU I was told on my first day to do compressions "HARD AND FAST and don't ever stop until the person running the code/the person at the defib tells you to."

My preceptor also told me to hum "Stayin' Alive" to myself to set my pace.

Of course this was my first shift of consolidation and we had a code that night. She couldn't believe that was my first time doing compressions. I told her I just followed her advice :) Good luck!

[Magaly63]

Yes, if you can do it first, do obtain a list of DNRs or full codes. I have worked at several LTC facilities and in all of them the form that the residents or responsable party are required to sign for DNR/CPR do state that initiation or continuation of CPR is at the discretion of the staff based on individual situations, efficacy or futility of interventions.

However, education is paramount, does anyone take the time to explain what happens during CPR? The success rate and age factor? Doing CPR on a 102 year old breaks our hearts.......