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.

[leslie :-D]

yes, MANY hospice pts choose to remain full codes.

not all hospices allow full codes to utilize their services, but any terminally ill pt has the inherent right to be coded...

as long as it is not r/t their terminal dx.

reading sev'l of the responses on this thread, i am wondering if the nurse too, thought this hospice pt was a dnr.

it truly 'sounds' like a system error.

may he rest in peace.

leslie

[twinmommy+2, ADN, BSN, MSN]

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.

unfortunatly in my area there are many hospice patients who are full codes. I'm not saying that people should not be allowed their beliefs to be carried out, by all means they should. But hospice patients should be dnr.

[BabyLady, BSN, RN]

I don't understand, how, for the life of me, such a detail could have been missed.

[leslie :-D]

unfortunatly in my area there are many hospice patients who are full codes. I'm not saying that people should not be allowed their beliefs to be carried out, by all means they should. But hospice patients should be dnr.

why, may i ask?

let's say a pt has 6 months to live...

and he has an mi.

why shouldn't he have the option of living the remainder of his life, to what he perceives at his fullest?

dying is a journey- not an isolated event.

people go through stages, and there are many loose ends to be tidied up.

it takes time, something that is now, sacredly precious to them.

leslie

[Ms.RN]

i work in ltc facility and we have many patients receving hospice care. we have many patients where family decides to place patient on hospice, assessed and admitted to hospice. they are admitted but they still have their old advanced directives in their chart which are full code. so we have to call their family or poa and ask them to sign a new advanced directives so we can put it in their chart. until poa signs new advanced directives stating no code, they still remain full code. so nurses cant assume that hospice patients are automatically no code and do nothing. they have to check their advanced directives and follow their wishes. i think facility that are involved with this hospice patient have to come up with a damn good reason why they didnt do anything when patient is a full code and they did nothing. and i think this nurse is also liable.

[morte, LPN, LVN]

related to the way the OP is phrased, i have to ask, Is this a homework assignment?

[leslie :-D]

i don't understand why this would be any bigger a deal, than a pt who clearly wanted to be dnr, yet is overriden by md/family in a code situation.

"if" this nurse is a criminal, then so is everybody else who has disregarded a pt's written wishes.

leslie

[gentlegiver, ASN, LPN, RN]

In the LTC I worked at, we kept a census sheet on our med cart at all times. We jotted down the shift report on it. I sat down (over a couple shifts) and went through all 40 charts and noted Code Status and Allergies along with any precautions the pt needed. All the Agency Nurses that came to my unit loved it. It really made life easier for the Nurses.

[April, RN, BSN, RN]

To the original poster, are you a nurse? I'm just wondering because the focus of the first post seems to be on what punishment the resident's nurse should receive. The OP also posted the same thing in a similar thread.

Unfortunately, mistakes do happen. We've all made them, or will most likely at some point in our careers. Even those of us reading this story here were a little confused at the situation since the patient was on hospice but still a full code, but there were no documents signed. Instead of placing blame and punishment on the nurse, this incident should be reviewed to find out why this happened and how this situation can be avoided in the future. I'm sure this resident's nurse really needs a lot of support from her co-workers right now.

[twinmommy+2, ADN, BSN, MSN]

why, may i ask?

let's say a pt has 6 months to live...

and he has an mi.

why shouldn't he have the option of living the remainder of his life, to what he perceives at his fullest?

dying is a journey- not an isolated event.

people go through stages, and there are many loose ends to be tidied up.

it takes time, something that is now, sacredly precious to them.

leslie

And you are right about that. Pt's should be allowed to be full codes if that is what they want. By all means, you may have the most terminal illness and may pass away tomorrow and I will honor your wish. If that person is a full code, should they also be in hospice? I don't think so. That is my opinion. Give them care and support, treat their pain and any other illness that comes along while terminally ill, yes absolutly. But if they are not ready for the end result of death then hospice care may not be appropriate for them. But then again I have never worked hospice. Just my

[txspadequeenRN, BSN, RN]

i absolutely hate it when they admit patients in my facility that are hospice and full codes...i mean whats the point ;to me that's a sign of denial and they need to have the doctor speak with them again about their condition. just my opinion

[SuesquatchRN, BSN, RN]

Neither of the hospices in my area will accept someone who does not have a DNR. If you are still fighting for time hospice is not the service you need.

I now that were a patient to code in any LTC in which I've worked their code status didn't matter because we didn't have AED's.