Full Code Help Please

With regards to your question of what charges can be filed?... only those in the legal field could respond to that. Another issue that should be addressed is:why is there no system to identify DNR/DNI patients? A huge sign is not necessary; our facility uses a special bracelet to signify no code status. Secondly, I don't know how anyone could determine from appearance alone how long someone has been deceased. The physician has lone responsibility for signing the death certificate, and it seems as though both MD's agreed that no resuscitation efforts should have been done, and autopsy was not needed. You didn't say whether the family is angry or upset, you just mentioned they declined a post-mortem examination. It's not clear why the DON would "threaten" to call the SBON; if she felt their was a real concern that should have been done, and an investigation would clear up any confusion. Hope this helps; again I'm not an expert, but a nurse with many years experience.

Morghan, MSN, ARNP, BC, CARN, ACM

The other night at work, the aides found Pt. non responsive called the nurse and stated what they found, nurse who had been floated to this hallway and not knowing pt well came out and yelled for the other two nurses. The pt. from the looks and feeling of it, had been gone for some time maybe hour or so. The nurse in charge of her, grabbed her chart and then seen she was full code, we are not allowed to have any labeling in rooms to determine full code or dnrcc, you have to go back to nurses station to see. This pt. was a 36 y/o with severe ms. The other nurse said that we could not do anything by starting CPR at this point, The MD was then called and told of the findings and that CPR had not been started d/t circumstances the MD never said anything and gave ok to release body. The question is The DON came in and threatned to call board of nursing and report the nurse in charge. Family does not want an autopsy neither does the MD or coroner. What charges can be filed and would all nurses there that night be in trouble? Please respond and sorry it is so long!

if the patient was blue, cold and stiff it should have been documented. that will support not initiating bls.

the pt's nurse should write an incident report.

I doubt that all the nurses would be sued; however, if the nurse in charge of the patient was not performing her duties I could only imagine she could be sued and have to prove herself innocent in court.

this is what my supervisor have told me. even if patient have deceased, if a patient is a full code, you start the cpr and call the 911. usually police arrives with ambulance, so you let the police see the patient and proove that there was no foul play involved.

i too, was taught to start cpr and call 911 on all full codes.

working in hospice, i don't have that problem.

but i would have difficulty starting cpr on a pt w/the onset of rigor mortis.

the don sounds a bit paranoid about legal repercussions, and is trying to absolve herself of any responsibility.

if the family seems ok with everything, there doesn't seem too much to worry about.

BUT.... it is highly dangerous to not have an efficient system in place re: identifying dnr and esp. full codes.

leslie

Thank you to those who have responded. I know that we can not say for sure how long she was gone, but all body fluids had been expelled and very cold to touch. When family was there they of course were upset because it was unexpected. When the DON finally quit yelling at the nurses and called the MD, he just said that there was no reason to do an autopsy. Everything has been charted and throughly looked at. As response to a way of labeling in Pt's room DNR status, it was brought up some time ago and nurses were told it was against HIPPA, and that we could just look at the charts. I know prev. places I have worked have had ways of marking in the pt's rooms sometimes marked with dots on the headboard of the bed, so only personal knew what they meant. I don't think anyone's family would object to that. Again thanks for the help.

When I worked in ICU, I took care of a few people who had been resusitated after a lengthy down time - it was very often not a good outcome.

I doubt this woman could have been resusitated at all.

I would have a problem initiating a code on someone who was cold, don't care what the DON thinks

Last week I had to initiate a code on someone who was cool to the touch, it's only for a couple of minutes until EMS arrives, then they evaluated and called a no-transport. This is cya procedure at my facility!

The facility I work at we are to start CPR as soon as we find them unresponsive if they are a full code. Its our corporate policy. We are to continue until paramedics arrive and then they determine to continue or stop. I'm just wondering why there is no policy on this where you work? I can't imagine you could get into any trouble unless the family files a neglegence report or something of the like. Whoever was in charge that night made the call based on their judgement and thats all they could do. As long as she has written this in her report I would guess you all would be in the clear.