Full Code resident in LTC

[BB00513]

I Work in LTC and a Full code Resident died. The doc was in the room and would not allow the nurse to perform CPR. What is the unwritten or written protocol? Was the nurse still responsible to perform CPR? Was the doc wrong for not allowing? Thanks so much

[Guest757854]

Hmmmmm.... i dont kno. I too interested in an educated response. And how would a nuse chart such an incident.....

[cjward3]

Unless the doctor was physically restraining me, I would be performing CPR on that patient, no matter what he said. I would call for another nurse to come in for a second set of eyes as well. No matter what the doctor's opinion is, a full code is a full code. You perform CPR until the medics come and take over.

[Gabby-RN]

In my state, it is appropriate to not initiate CPR on a full code patient If they have signs of irreversible death: rigor mortis, or dependent lividity. When the patient was found to not be breathing/pulseless, had rigor set in or was there dependent lividity? Possibly this is why the doctor stated to not initiate CPR.

[Blackcat99]

I would have checked the patient's chart immediately to see if the patient had a legal DNR form(No CPR) in his chart. if he did not have the required legal DNR form I would have started CPR immediately. It sounds like this was a full code resident who did not have the required legal DNR form.

[HappyWife77, BSN, RN]

We need more to details......

What was the patient doing ?

Who found them?

Was someone a witness ?

Why was the Dr in the room?

How long had the patient been unresponsive?

A full code does not mean they will always live, but we definitely will try to keep them breathing and heart pumping and call 911.

I wonder if the Doc pronounced them because he knew something we don't know?

As far as I know...a full code status or DNR status is up to the patient and/or POAs, not at the discretion of a Doc to change when they see fit.

[Sun0408, ASN, RN]

I agree, more details are needed. How long was the pt down??

[Gabby-RN]

I think how long the patient was down is the most important fact and if it was witnessed or not. If the patient died in their sleep for example and was found by the MD during morning rounds, clearly dead for some time and the MD determined the patient was dead, it would make sense why he told the nurse not to do CPR. A doctor after all is within their scope to pronounce death, full code or not.

[cjward3]

I read the post as the MD was in the room as the patient passed, not necessarily that the doctor discovered the patient. Reading it in that context, then yes, I do agree that more detail is needed. However, if it was the case where the MD witnessed the patient stop breathing, then I stand by my prior statement.

[withasmilelpn]

Interesting article addressing just this issue:

Can Doctors Impose Do Not Resuscitate Orders? They Can | White Coat, Black Art with Dr. Brian Goldman | CBC Radio

[withasmilelpn]

Another useful article:

Making Decisions: CPR & DNR Orders

[NurseQT]

This will also depend on the facility's protocols.. I have worked in LTC facilities that were "no CPR" and every resident was made aware prior to admission that should they go into cardiac arrest the nrg staff wouldn't initiate CPR. I have also worked in facilities where the protocol was CPR would only be initiated if the nurse was in the room and witnessed the resident stop breathing. CPR or no CPR no LTC facility that I have worked in had a defibrillator...