deceased patients

[cariad]

I reently had an experience on night shift and am confused with whats right and whats wrong. we had a 77 yr old emaciated male, who had a turp and was due for discharge, I medicated him at midnight. there were me...an RN and 2 LPN'S with 20 patients, so I was taking care of 7 patients, no nursing co-ordinator on duty...just someone at home on call. I went back into the patient's room at 1am and the patient was very obviously dead, no vital signs, no pupil response, arm lying on the bed, cool to the touch. so I immediately contacted the er doctor...the only one in the hospital who came immediately, I asked on the phone whether to call a code blue and he said no. on arrival in the patient's room, he confirmed the death. so no code was called as the only other person who would have come in the middle of the night would have been the respiratory therapist, and maybe an er nurse.

so now the co-ordinator is saying that I should have called a code.

I have looked up the hospital protocol which states that cpr should be initiated if there is not a dnr signed.....unless the physician at the TIME of the arrest determines that resusitation is not medically indicated.

what should the protocol say regarding the time as no-one was there at the time.

although in hindsight I should have just called the code to cover myself, at the time I wasnt sure about the protocols in finding a patient dead. so I took advice from my superior which was the doctor.

the patient obviously had some underlying problems...he had an abnormal ekg prior to surgery, but he was medically cleared for a spinal.

am going to a meeting monday with co-ordinators to clarify the situation.

[pricklypear]

Sounds like you work in a very small hospital? Our policy, and it's policy everywhere else I've ever worked is to initiate CPR on any patient without a DNR order. Even if the patient is "obviously" dead.

[gypsyatheart]

If no DNR order exists, you have to call a code. (Was there a DNR on the chart?) That way the MD that comes in can pronounce the body, but we still have to initiate a code.

[meownsmile, BSN, RN]

Most facilities require any patient that doesnt have a legal DNR has to have a code called and CPR initiated until the doctor on the code team determines it is not medically beneficial. If nothing else to be able to enter proper paperwork and notes into the legal chart. I know it sounds almost cruel to climb up on someone and initiate but technically you dont know how long they have been in arrest.

Possibly if the doctor you spoke of was the patients doctor and he made the decision not to code, you may be covered and he will be the one who takes the questions. Otherwise, always call the code.

[CritterLover, BSN, RN]

yeah, have to agree with the others......you should have called a code.

from a human standpoint, i'm kind of glad that you didn't, since it just doesn't seem right to pump on the chest of a patient that doesn't seem to have a chance.

but from a legal standpoint, you really should have.

[snowfreeze, BSN, RN]

You can document lividity and not start CPR or have the doctor make the call like you did. Usually CPR is started but I think you made an educated decision. When you make such decisions you do need to document what you observed and what you did. Favorable arguement would be that a very low percent of unwitnessed cardiac arrests survive and about 5% of the survivors of witnessed arrests in the hospital actually go on to have any meaniful or quality life. Most are trached and peg'd and sent to a specialty care facility or sub-acute nursing facility where they finally succumb to pneumonia, a UTI or pressure ulcers. And yes I have done CPR on multiple witnessed and unwitnessed arrests in adults and children. Some regain pulses and spontaneous respirations, most don't.

[sirI, MSN, APRN, NP]

Yes, you should have started the code.

I know you know that now.

[pricklypear]

You can document lividity and not start CPR or have the doctor make the call like you did. Usually CPR is started but I think you made an educated decision. When you make such decisions you do need to document what you observed and what you did. Favorable arguement would be that a very low percent of unwitnessed cardiac arrests survive and about 5% of the survivors of witnessed arrests in the hospital actually go on to have any meaniful or quality life. Most are trached and peg'd and sent to a specialty care facility or sub-acute nursing facility where they finally succumb to pneumonia, a UTI or pressure ulcers. And yes I have done CPR on multiple witnessed and unwitnessed arrests in adults and children. Some regain pulses and spontaneous respirations, most don't.

This argument will not hold up legally. The entire point of starting CPR on anybody without a DNR is that you never know. Yes, they may end up brain dead, on a vent forever. That's not your choice to make - it's theirs. If they do not have a DNR order, the patient EXPECTS attempts at resuscitation, and they should get it. It's not about what we want, what our experience tells us, or what we think should happen.

[snowfreeze, BSN, RN]

Believe it or not, the arguement, lividity and of course rigidity has held up in court for not starting CPR.

No we do not really have the time to consider the outcome prior to starting CPR. Yes all patients who are full codes should have resusitation attempted. I was only trying to consider this nurses decisions in this case.