if in doubt of code status should CPR be done ?

[NurseLoveJoy88]

A few weeks ago a resident was found unresponsive by the nurse, the nurse did not know the code status and didn't do cpr, it was later concluded that the resident was a full code.

This has brought up a lot of thought at work. Now clearly the nurse should of had someone check the chart and did not do so.

My question is: if I find a resident unresponsive and don't know the code status right away should I start cpr or should I wait until the code status is determined ? I was personally taught to do cpr when in doubt however the directer of the facility seems to think otherwise. Please clarify.

[ghillbert, MSN, NP]

You can fix a lawsuit. You can't fix dead. Resuscitate until proven no-code.

[Bill E. Rubin]

I'll add that in an ideal situation, if a pt starts crumping and you don't know their code status, you can delegate someone to look it up while you're still assessing if the pt has a pulse/needs CPR. At the worst if you discover that the pt is a DNR you can stop doing CPR sooner if you did start chest compressions before finding out. At best you'll find out before you have to start doing compressions.

[NursePeace]

START CPR. And the doubt should be limited to a second. As in someone better haul a** to figure the code status out, If this is not possible, find yourself a new job asap. As far as your DON goes, her time as a nurse sounds limited. Our code status papers are the first thing thats pulled from our admissions packets and signed by PT and MD asap. If we do not have both signatures, pt remains a full code. Good luck!

[jjjoy, LPN]

While I agree that it's bad policy, I can see where the person may be coming from. And that can be helpful in discussing the policy and making changes as opposed to blasting someone with "How could you even THINK that's okay?!!??!!"

I'm guessing this is a nursing home where mostly elderly patients have long-term chronic health conditions, recovery or improved quality of life is not the goal. Goals are more like minimization of exacerbations, prevention of complications, and general health maintenance to try keep an already compromised quality of life from deteriorating faster.

ER and ICU are for heroic life saving, not nursing homea. In ERs and ICUs, they have very low nurse to patient ratios specifically so that the nurse will catch any downturns in status and jump on them STAT!. In a nursing home, it may be 30:1; the nurses are not expected to know exactly how each resident is doing at any one point in time. If the patient hadn't previously shown any signs of change of status, and later alone in their room passes from a stroke or MI, it may be sometime before the death is discovered.

So if a staff member just happens upon a resident who is lying inert and may perhaps not be breathing or have no pulse, I can see where a someone could justify not shifting immediately into "try to get this person breathing again STAT!" It's not at all unlikely that the person has been lifeless for some time already. And that it could be considered a blessing to pass. After all, some nursing homes may be predominantly populated with residents who already have a low QOL and, if revived, simply look forward to further deterioration and yet another death experience in another few days or weeks or months.

I can see the problems with these arguments. And am not looking to debate them or defend them. I'm just putting them out there since the OP didn't seem to have any idea why someone might entertain this kind of policy.

[bjaeram]

So if in doubt you just let them die???? REALLY???

I'm pretty sure I'd be more ****** that you did nothing for my full code Grandma then if you had pumped on my DNR Grandmas chest a few times! I can't even begin to tell you how mad I would be if a nurse found my Grandma unresponsive and just stood there doing nothing because she wasn't sure if Grandmas wanted to live or die.

[Perpetual Student]

jjjoy, I am in complete agreement with you from a moral and pragmatic point of view. Unfortunately, this is an example of where what is right does not correspond to what is legal. If you fail to act you run a major risk of getting successfully sued, and perhaps even charged by an overzealous prosecutor looking to make a name for himself.

[Medic/Nurse, BSN, RN]

Thank you both for the replies. I'm still bothered by the director of the facility thinking nothing should be done until the code status is determined. The director even stated one can be sued for doing cpr when in doubt, if the person was a dnr. As for me, I'm sticking to what I know and that's to start cpr when in doubt.

Wow - I am shocked.

You have it right. When in doubt - meaning not known for CERTAIN - start CPR per facility policy at once. You are in a battle to save the brain that starts to end (in the best case) in ONLY 4 minutes once breathing stops. Take the time and go check and I will promise that it will not matter - but, IF they are a FULL CODE and it is my family and I find out that everything STOPPED until ANSWERS are found - there will not be ANYTHING that will save the nurse (or facility) that does such a IDIOT move. I will own it all and I'll take the license for fun. Really. Your director is giving you "bad advice" - what does the "policy" say.

Maybe DNR folks should have arm bands, door signs or a flower color that indicates their "status" for those situations when the chart is hard to find or action must be decided ... now.

Tough spot. You are in an unhealthy place. You are at risk - personally and professionally IF you heed the "warning" of your director. I hope you find something else soon.

Until then - follow policy and use common sense.

I would always rather explain why I did something as opposed to why I didn't. I need a better reason NOT to act than to act.

Good Luck.

Practice SAFE!

[dannyc12]

A few weeks ago a resident was found unresponsive by the nurse, the nurse did not know the code status and didn't do cpr, it was later concluded that the resident was a full code.

This has brought up a lot of thought at work. Now clearly the nurse should of had someone check the chart and did not do so.

My question is: if I find a resident unresponsive and don't know the code status right away should I start cpr or should I wait until the code status is determined ? I was personally taught to do cpr when in doubt however the directer of the facility seems to think otherwise. Please clarify.

From your description, the director of your facility is a moron and the staff of your facility is incompetent.

Nurses have a responsibility to know the code status of their patients. It's kind of a big deal.

[NursePeace]

Just a FYI...Full code should ALWAYS be viewed the same way its viewed in an acute setting. You have a responsibility as a nurse to uphold your patients wishes regardless of age or dx. Yes I have 24 patients and yes I know all of there codes. But as far as "finding a pt who had been dead for sometime" Not on my watch. When and IF I ever transition to an acute setting, my patients full code status will have the same definition and urgency.

[bill4745, RN]

Some facilities have "No CPR" bracelets similar to the ones for allergies, fall risk,etc.

[RNperdiem, RN]

Do the CPR. You can't hurt the dead.

[cjcsoon2bnp, MSN, RN, NP]

Initiate CPR if you are unsure of code status. Check code status as soon as possible and then act accordingly.

!Chris