MD's and Code status

[PRNnightnurse]

Hi All,

I am fairly new to this BB so I don't know if you've all covered this one before but here goes.

I get SO frustrated:( with the physicians and how they determine a patient's code status. I have never heard a physician go into any detail with patients regarding CPR and all that go with it.

Usually the doc's ask the patient what they want us to do if their heart should stop or they should stop breathing. The patient usually says, "Everything but I don't want to be on any breathing machines" or "You can give me medications but no CPR". The doc's then leave it at that and write the order as such.

Don't you think the doc's should explain CPR or a code situation more clearly to the patient? Explain to them that if you code you will be on a breathing machine or if you code and your heart stops, medication won't do any good if your heart isn't beating to circulate the medication.

Maybe I am wrong, but patients have no idea what a code is like and families are worse. Don't get me wrong, I don't necessarily advocate everyone being a no code or anything like that. I just think that patients could make a more informed decision if they have the whole picture and understand the situation clearer.

Thanks for letting me vent and I'd be interested in your opinions.

:wink2: Jacki

[micro, RN]

In my experience, ten + years of nursing.......there are a "few" doctors that are GREAT about talking with patient and families about advance directives, etc. But there is also doctors that when talking to patient and families, only present the upside of a situation..........

It seems to fall more than less, to the nurses that are comfortable with this area of discussion to initiate, discuss, provide emotional support and laison(chk splg) social services and doctors to facilite DNR orders and further advance directives. I have found myself in this place more times than can remember. I believe in knowledge, and the right of informed ability to choose what will and won't be done. I find it much easier in my nursing to follow care in a full code situation.......if I know that all options have been presented and an informed choice has been made(even if in medical outlook, things look unfavorable).

just rambling, so will quit..........

nursing, it falls to us again most of the time.

I encourage my patients and their families to work toward being of the same mind themselves and then being an active participant in their care(all aspects) Often patients are treated as if doormats, when in reality.....that is why we are all there.

OOOOOPSsssss, didn't quit.......

I am glad you brought up this subject, Jacki. It is something that we "all" deal with.

micro

[bestblondRN]

Jacki,

I have to agree with micro on this topic.....some docs are terrific about approaching the patient and family about code status, and others are either really bad at it or seem to have a lot of their own issues about death, and are therefore biased.

As nurses, and as the ones who generally build the rapport and relationship with patients and families while they are hospitalized, it often falls to us or the social worker or pastoral care to educate and follow through with the patient/family about advance directives and code status. I have had the discussion with patients and families many times, and I don't give them all the nitty gritty of what is involved in a code situation right off the bat. I try to assess where they are in their understanding of the person's illness and prognosis first. If they are way off base, then I need to begin there and start educating them about disease, prognosis, etc. That often sets the stage to eventually have the discussion about what they want if their heart stops, they stop breathing, etc.....I have found that there is a lot of ambiguity and concern on the part of pts/families that making someone DNR equates to withholding treatment, so I always make it a point to address that issue and reinforce that if their deccision is DNR, we will continue treatment. When they come to a definite decision at that time, I communicate it to the physician and I document the patient's/family's wishes.

Hope that helps!