Full Code Not Carried Out

[FELICIA33021]

A terminal ill patient was admited to the nursing home. Physican wanted him evaluated by Hospice, they admited him to their services. He told them he want to be a full code. He declined signing the DNR papers and the order was verified by several nurses. He was found unresponsive. The nurse did nothing, she just assumed the pt was a DNR, never checked the chart. We work at nursing home so hospice has to be called about the resident every change. The code was not iniated at all. The unit manager knows and nothing is being said. What should happen to the nurse that was responsible for his care.

[Straydandelion]

Not knowing how your facillity works I would say the doctor and unit manager definitely needs to be informed then go from there. I am not quite understanding the patient being allowed into hospice with a full code but things may have changed. What was documented on the chart/what did hospice say? I am also assuming there is no set designation for code status in the patient's room?

[blondy2061h, MSN, RN]

I don't understand how someone on hospice could be a full code. Or was he not on hospice and I'm reading this incorrectly?

[Blee O'Myacin, BSN, RN]

Was he found unresponsive, or dead? (Meaning - no pulse, no respirations, already cool?) I would think that even a full code who was found dead for quite some time would not be coded whereas a person who was still alive but in trouble, or had a recent repiratory or cardiac even could potentially be given CPR with a slight possibility of recussitation and transfer to the hospital.

But to address the OP's issue, does this hospice still allow patients who are a full code? If not, was it ever addressed that the patient was not on the hospice service? (I am assuming that the facility in question has hospice patients, but is not dedicated for this, correct?) I guess a different colored ID band would help differentiate residents rather than a sign above the bed.

Blee

[notnightengale]

To bad its just like any other nurse error that cost a paitent their life...This was this mans wish and intential or not this nurse and staff were to carry out the code..Thats their job! It now rests with the upper hand to do theirs if they have been informed by the staff of waht happened then like any other incident that is the chain of command. This is just another case of when someone assumes thay make an ass of themselves and in this case gives nurses a bad name!!! Also... YES ....it is possible to be a full code on Hospice...

[norcalRNstudent]

I've never seen a Hospice group that will allow a full code patient. They are mutually exclusive ideas- one is comfort care, and the other is by any means necessary.

[Jolie, BSN]

I've never seen a Hospice group that will allow a full code patient. They are mutually exclusive ideas- one is comfort care, and the other is by any means necessary.

I respectfully disagree. Hospice is intended to enhance the quality of life of patients with life-limiting illnesses, not simply provide comfort measures. While they may not be aggressively pursuing a "cure" anymore that does not preclude a code. For example, a relatively stable patient who has opted to discontinue aggressive cancer treatment may experience a cardiac arrest due to an unwitnessed choking episode. To not institute a code would unnecessarily cost this patient his/her life.

Hospice and codes are not necessarily mutually exclusive.

[pink85]

It sounds to me, in my opinion, that the nurse that withheld CPR needs to be confronted and that situation dealth with as well as the facility should probaby come up with an effective way to determine who is a DNR and who is not.

[Batman24]

This is a situation where I would be grateful I wasn't the nurse and just kept about my own business. Chances are this was a mistake based on an assumption he was no code as he was terminal. I'm sure anyone involved in something like this would feel awful. Let it be a good reminder to all never to assume anything.

Your unit manager might deal with this privately with the nurse. I don't know if she will be terminated, reported or not. Might just have to wait and see if she remains employed.

[oramar]

I don't like the term, "what should be done to the nurse". She is not a criminal and there is no need for punishment. Sounds like an honest mistake. It is dangerous to assume things in healthcare but thinking a patient who is being worked up for hospice was a DNR would be a mistake anyone could make. Also, if the instituion has no system for denoting code status it is as wrong as she is, maybe even wronger.

[lwd338]

We just sent a gentlman to hospice yesterday, he didnt have a DNR inplace so his discharge was held up till the resident came and wrote one. (per Hospice)

[Virgo_RN, BSN, RN]

I don't think anything should be done to this nurse, but I do think the procedure for identifying code status in this facility needs to be examined and improved. An assumption on my part is that if this is a nursing home, the patient's chart is at the central nurses station, not anywhere near his room. If code status is contained in his chart, then this means an unnecessary delay in treatment if the person is full code, and as others have mentioned, the fact that this patient had a terminal illness and was admitted to a nursing home to be evaluated for hospice would not make it a big leap to assume they were a DNR. Now I do not condone making an assumption over actually looking at the code status, but in this instance, I think it was a mistake and it sounds like the process needs to be improved rather than the individual nurse punished. Involving that nurse in the process improvement process would be a good way to hold her accountable for her mistake and give her an opportunity to atone for it.

For example, one facility I worked at had every resident's care plan posted inside their cabinet door, so that any caregiver could look at the care plan without leaving the room. It was not a HIPAA violation since the care plan was not in plain sight. This made it easy, if a care giver had any question about the resident's care, to just go over to the cabinet and look at the care plan. I don't recall if code status was on there, but it would make sense for it to be.