Ever see "FULL LET" for code status?

[shygoofyone]

We had a new Doc start yesterday in the ER and for a patient with a uniform DNR order, he wrote "Code Status: Full LET" None of us, including nurses with over 30 years experience, have ever seen this term. We asked him what it meant, and he said "that's what you write..." then sat down to try to find the damned meaning on Google! I'm terrified that he's going to be working alone on 24 hour shifts....talk about handholding! Aside from that...has ANYONE ever seen this?

[tyvin, BSN, RN]

And again Esme12 educates us all ... thank you for that link. It appears that a LET order is the same thing as a DNR order. I can't imagine a facility going with the LET system of orders unless they trained the staff first. So I think you should inform your resident that until the facility goes that way that perhaps he should follow policy and procedure for now.

Also, I have had the wonderful experience of moving from the West Coast to the East Coast ... I could've sworn I was in a different country. Plus I didn't just move to the East Coast I moved near Amish people to boot. My mother didn't believe me when I called her up to tell her about the people who rode horse drawn buggies for transportation. What a wonderful experience. And the Amish people were oh so very polite when I would come across them often at open markets and thrift shops.

The first time I went into a store to buy some groceries I couldn't find any of my brands; nothing, and everyone thought I had an accent. The confusion with pop and soda, pop and soda ... just tell me where they are please. Quite the experience.

[NeoPediRN]

Full LET sounds like they wouldn't use NIPPV like bipap/cpap for respiratory distress, whereas a regular DNR does allow for emergency treatment, just not cardiac resuscitation and intubation.

[fallinnstyle]

This thread is educational on many levels....

I live in the south. We don't have fancy words for this stuff.

Actually, until I moved south, I thought a peripheral iv was either a saline or hep lock. You should have seen how confused I got when I was asked to help place a INT.

[shygoofyone]

One of the benefits of a large forum such as allnurses.com is that it allows you to hear about terminology/equipment brand names/practices that may be different from those in your local area.

Though I have worked with a few professionals who consider anyone who does not use the same lingo to be "clueless" or "scary".

I certainly have no problem learning new terminology. But, if a new doc thinks it's okay to use an abbreviation he himself can't explain...I will remain worried about him being my only doc in the hospital.

[shygoofyone]

No clue - haven't heard of LET but why didn't anyone call and ask the MD? Isn't that what you do when you have orders that you can't understand? Best to be safe than guess - get some clarification.

If you read the original post, we actually confronted him about it right when he wrote it, hence us seeing him fail to explain it and then sit down and attempt to Google the answer. I don't care how stupid I may sound asking a doc a question, if I don't understand an order, I ask.

[shygoofyone]

Figured it out!

Google "Limitation of Emergency Treatment LET"

Click on the PDF entitled, "Faculty Handbook - University of Illinois at Chicago"

On page 13, you can read all about LET orders!

Thanks! I kept trying to think of terms the abbreviation may have stood for and go nowhere with my searches.

[tvccrn, ASN, RN]

Wow, I never realized that "Johnnies" is only used here! (I'm from Boston)... And there are no milkshakes here...just frappes :)

It is not just in the NE area. I was in Wisconsin for years and it was a johnnie there as well.

[shygoofyone]

I got a different impression from the OP ... particularly the description of being "terrified" and "handholding".

We can agree to disagree.

My reason for using those terms is that we are a small rural facility with only one doctor in the building at all times. If I have a doc that thinks it's okay to use a term he can't even explain it does make me wonder how well he'll react to other questions and problems that arise. I don't think it's acceptable to use a term in any charting that you, as the writer, can not explain. When you have to rely on only one doc, you have to trust that he'll be able to communicate with you, no matter what your question is. What scared me most was his lackadasical attitude.

[Old.Timer]

ShyGoofyOne, I could not agree more....when the guy could not explain to you what he meant by his order that pertained to nuances in code status I would be very concerned also.

On a side note, thankfully, it is now accepted practice to write specific DNR orders in the chart. When I began nursing, I worked on a specialized oncology unit in a teaching hospital. At that time (very early eighties) in that facility, that was not done. Nuances of code status were communicated verbally between the physicians and nurses and in report. I know...... pretty unbelievable and scary to think about that now.

The two I remember most were:

"slow code" meant use overhead to stat page the resident once signs of life were absent and they came and pronounced.

"stat page" meant get the doc/resident that would be familiar with the patient there before the code team so they could direct level of intervention.

We raised holy hell about not having an order b/c not only did it place staff in legal jeopardy, you still ended up with cases of totally inappropriate full blown codes. Eventually, change occurred and they began writing specific orders.

Our group of nurses on that unit were some of the fiercest patient advocates for death with dignity. I once had chemo orders for a patient that was clearly in her last hours/days of life. I questioned it and was told, yes, Dr so and so still wants the chemo infused. Horrid N&V was common back then. I called him in clinic:

Me: You need to come up to pt A's room

Him: Why?

Me: So you can give her the chemo you ordered.

Him: What do you mean? You have the orders for it.

Me: I'm not giving it, she is actively dying. If you want it given, you need to come over and do it yourself.

Him: Okay, you can cancel the order.

I realize it is a different world now and very few nurses would feel comfortable pushing back that hard. But to the extent possible, continue advocating for the patients. We can make a difference. Look how far we've come.

Sorry, I obviously went a bit off tangent from the original topic :)

[Roy Fokker, BSN, RN]

Any doc who writes orders the nursing staff can't understand nor comprehend is setting 'emselves up for a world of trouble.

- Roy

[dthfytr, ADN, LPN, RN, EMT-B, EMT-I]

If the term is unclear, the document doesn't mean anything. I would have guessed "Life Extending Treatment." That's why abbreviations have no place on a legal document unless they're explained elsewhere on that same document.

[StrwbryblndRN]

I am from southern louisiana and we always used coke to refer to any sodas.

"Can I get a coke?".."sure, what kind?"..."a sprite". Weird I know.

I learned recently that electricity to your house is called "current". Not everyone uses it here though.