Didnt attemp CPR to a rigor mortis patient

Nurses General Nursing

Published

Hello,

I am here for a co-worker that's very stress out regarding the incident that just happened at the facility where we're working for. Per her statement, she walked in to a patient's apartment and found him laying on his side unresponsive, blue-purple in color, very stiff and cold. She called for help from co-workers that was working that time but nobody responded. She called 9-1-1 and stated resident wasn't breathing and the operator told her lay the resident flat and perform CPR (operator didn't know that patient is in rigor mortis). Also, she was all by herself by that time. Few minutes later, helped came and turned the patient on his back. She explained to the operator that patient is very stiff (one arm on the air, one leg is on the other, other arm is curled next to head). The operator then stated "oh so he's beyond cpr?" and she answered "yes!". Then operator transferred call to fire department and give same information. But the fire department didn't instructed her to perform CPR. No CPR attempted until paramedics came When they arrived, they announced that patient is in rigor mortis and called fire department no need to come.

Police Dept came for investigations, family and RN came (it happened weekend so no RN on duty).

Later, DSHS was involved and did an investigation. DSHS arrived in our facility and asked questions for protocol for unconscious patient. Then, DSHS representative asked to talk to my co-worker regarding what happened. Also she (DSHS) asked her (co-worker) if CPR was attempted.

Now, my questions is. 1 Is it serious (bad) when DSHS involved? OR is it just a standard procedure for them to get involved? 2 Is she gonna lose her license for not attempting CPR as CNA (since the protocol in our facility to perform CPR until paramedics arrive) even resident is in rigor mortis ? Resident signed for DNR on his POLST form.

Please help! She's very stressed out and I felt bad for her being concerned that she might lose her job. She's been working in the facility for 5 years.

If the patient signed a DNR, one shouldn't have done CPR (even if it had worked)

I'm surprised that any facility's policy would have employees doing CPR on someone with a signed DNR.

Am I missing something?

Exactly! That was her defense. Patient's POLST stated a DNR. But the Director of the facility told her "you should have performed CPR still until paramedics arrive" another co-worker told her "you're not the one to decide 'to not attempt' CPR". And that is what upsetting/stressing her out.

Specializes in NICU.

If a patient is a DNR, then we don't do CPR. It's simple as that. I'm not sure why the director would have said she should have initiated CPR, that makes no sense.

Specializes in Critical Care/Vascular Access.

Did the director and coworker not know the patient was DNR? I mean, if the patient had all the proper paperwork done to be DNR then there should be no question at all. No CPR should have been performed. In fact, you would have possibly gotten in trouble if you HAD performed CPR on a DNR patient.

Specializes in ER, Trauma ICU, CVICU.

Why did she call 911? If I find a dead body, I'm just gonna call the nonemergency line. It wasn't an emergency. From the sounds of it, he was VERY dead.

It is unethical to do CPR on a person that has a DO NOT RESUSCITATE order. If I were a person that had a DNR and someone did CPR and brought me back after I coded, I would be ******! What if that person has terminal, painful cancer and wants to go? The coworker was right about one thing, "you're not the person to decide not to do CPR" The patient already made that decision.

This is an easy one...

POLST form says DNR... then no CPR...

The rest of the story is extraneous.

Specializes in NICU/L&D, Hospice.

I can't imagine if someone performed CPR on a person with a DNR and (although rare) the pt survived, brain dead and in a vegetative state for the next 5 years. THAT would cause a pretty good lawsuit. Your coworker needs to be "armed" with the information that pt was a DNR and even though 911 directed her to perform CPR, it was against the pt's wishes and was honored. Facility protocol to perform CPR until EMS arrives does not trump a patient's wishes for no CPR. The PATIENT decided that and your coworker honored it. God bless her!

Specializes in RN, BSN, CHDN.

My question would be how come nobody looked in on the patient for up to 12 hours?

That would be what I would be investigating not the DNR order-3 hours for rigor to start setting in but for body to be in the condition the OP describes it has to be closer to the 12 hours

I'd have to say your coworker is very safe from a legal stand point. I worry that the administrators for your facility care more about their policy than the patient's wishes. I would tell your coworker to make sure she performs exceptionally well for a few months in case they look to fire her. Also if they DO fire her, she can file a wrongful termination suit on the bases of a) there was a DNR which means it is at that point ILLEGAL to perform CPR (it becomes a battery charge) and b) the patient was well beyond CPR to begin with. However from a legal stand point the admin and doc are correct, your friend is not the one to decide no CPR as she has not been trained to a level to be able to legally recognize how far gone a patient is or if one of their conditions is causing a rigidity symptom. Your coworker is protected in this though by that DNR order because that removes her ability to perform CPR. Although I would review that particular DNR because some of them are more specific about what lengths to go to and CPR could be listed as an acceptable measure.

Specializes in Pediatrics, Emergency, Trauma.
My question would be how come nobody looked in on the patient for up to 12 hours?

That would be what I would be investigating not the DNR order-3 hours for rigor to start setting in but for body to be in the condition the OP describes it has to be closer to the 12 hours

That is MY question...what is the protocol for "checking in" on residents in your ALF?

Specializes in NICU.
My question would be how come nobody looked in on the patient for up to 12 hours?

That would be what I would be investigating not the DNR order-3 hours for rigor to start setting in but for body to be in the condition the OP describes it has to be closer to the 12 hours

I was wondering this as well. To find a pt in rigor mortis means they were dead for quite awhile. I don't know about you but I try to at least take a peek on my patients hourly.

If he was in arrest, and had signed a DNR, then she did the right thing by respecting his wishes and not attempting to resuscitate him, regardless of how long he was dead/unconscious/whatever. No pulse + DNR = no CPR. She will be fine if everything you say is true. It's probably a standard investigation.

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