Didnt attemp CPR to a rigor mortis patient

[Nar09]

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.

[Asystole RN]

In my state nurses, both RN and LPN, can declare death when certain conditions exist such as no pulse, no pupillary response and livor mortis.

Rigor mortis usually takes several hours to set in so there might be an investigation to if this facility was not something like an assisted living where patients are not expected to be seen for extended periods of time. If this was a rehab or LTC there might be issues.

Generally, there will be an investigation for any non-expected death but this depends on circumstances and your state.

[wooh, BSN, RN]

Assisted living isn't checked on hourly. It would be almost like, "Why didn't you catch your home health patient that has twice weekly visits before they were in rigor?"

[Nar09]

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

hello! Yes, Friday Afternoon patient is placed on a safety check per shift. So that's 3x a day check. The NOC worker wasn't question about this (as far as I know). But I agree with you.

[Nar09]

In my state nurses, both RN and LPN, can declare death when certain conditions exist such as no pulse, no pupillary response and livor mortis.

Rigor mortis usually takes several hours to set in so there might be an investigation to if this facility was not something like an assisted living where patients are not expected to be seen for extended periods of time. If this was a rehab or LTC there might be issues.

Generally, there will be an investigation for any non-expected death but this depends on circumstances and your state.

Our facility is a retirement/assisted living. This patient is in an assisted living department.

[Nar09]

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

sick/not feeling good. we place the patient to a safety check per shift. Sometimes it is an every 2 hour safety check. But with this patient case we only started the safety check per shift Friday afternoon because he started feeling ill Friday morning. He started wheezing, vitals not normal. He was brought to urgent care that Friday afternoon. When we came back Saturday morning, I was kinda frustrated why the patient was not brought to ER for more evaluation or test.

[BrandonLPN, LPN]

Assisted living isn't checked on hourly. It would be almost like, "Why didn't you catch your home health patient that has twice weekly visits before they were in rigor?"

Yes, this. I think some people are looking at this from the perspective of an acute care nurse.

Many assisted living facilities are basically apartment complexes where caregivers only check in on some residents to bring them a meal tray or make sure they've gotten dressed and stuff.

To have a staff member physically check on an ALF resident hourly would actually be a violation of privacy.

[DosmoRN]

I don't know what kind of investigation is taking place. But surely this care-giver will not be in serious trouble.

I don't see how she would be in danger of losing either her job or her license. As I see it, the policy of the facility concerning CPR, would be completely CONTRADICTED if the patient had a DNR order (as this patient did). Sounds like the care-giver got a bit rattled at the scene, thus her call to 9-11 and the resulting confusion.. But what she actually did was to OBEY the DNR, which in this situation, was the RIGHT thing to do! How could her job or license be in jeopardy when she followed the proper procedure (DNR).?

[nurseprnRN, BSN, RN]

Rest easy. Standard for BCLS and ACLS is that if there is rigor mortis, dependent lividity (indicating the blood flow stopped long ago enough that the blood has settled to dependent areas by gravity), or beheading (!), the patient has successfully died and no CPR need be attempted.

[jalyc RN]

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 was my thought too. Her big concern should be the fact that this man was neglected for so many hours in a place that had accepted responsibility for his welfare. BUT we all know facilities are more concerned with profit than true care.

I had a similar situation with a man who was found in rigor mortis, even though the CNA lied and insisted she had checked on him every hour as per our protocol. The nursing home covered up everything, lied about facts, and this woman was not even fired. So, I doubt that your friend has anything to worry about.

[Here.I.Stand, BSN, RN]

I would be more worried about her job if she HAD attempted CPR on someone w/ a DNR order. The resident's autonomously agreed upon wishes and written order to NOT ATTEMPT resuscitation trump any facility policy to perform until EMS arrives. To me, that policy assumes the resident is a full code. In any case though, this man was dead. Not unresponsive, not pulseless...DEAD. We can't resuscitate a dead person any more than we can supernaturally resurrect one. To perform CPR on someone who is clearly dead is extremely disrespectful of the body, I think.

I can't say for sure why the investigation is happening, but I would be flabbergasted if she was found in error. He had that DNR order.

[Here.I.Stand, BSN, RN]

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.

Well than this director is wrong. She didn't decide not to attempt it. The resident did, hence the DNR.

[kalevra, BSN, RN]

Pt had DNR signed. NO Chest Compression per their wishes, you can not get in trouble.

They were beyond dead, rigor mortis is way way dead. If you even started compression, it would be just for show.

The director probsbly just wanted to put on a show for the paramedics. Like look were doing everything, its not our fault. But if they have a DNR there is no point in doing it.