How long to run a code?

[smary8055]

I work in long term hospital in ccu, we are all acls certified how long do we have to run a code before we can call it when no doctor is going to come in to see pt.. some of out soctors are at least 45 mins away and refuse to come in when the pt has expired.

[AlwaysLearning247, BSN]

On 1/6/2020 at 8:50 AM, smary8055 said:

every word is true, no doctors, pa or np, in house at night only on call, pts or families sigh a paper acknowledging this at admission. stand alone, speciality , ltac and rehab hospital. Its called CCU, we do vents, gtts, everything. I know of other such hospitals that operate like this also!!! Ihave worked acute care ICU. this place in a real hospital would be like a step down unit. most doctors on staff, live at least 40 miles away, by the way I am RN with 25 years experience in ICU,

I worked at a LTAC as well, but when the patients crashed we did what we could while calling 911. We also got sick patients, step-down level with vents, trachs, drips, many straight from ICU, etc. The floor I worked on was also called CCU. At the LTAC I worked at we had a doctor at all times, although they would be sleeping and someone would have to run to them during an emergency. The doctor would always send the patient out when they weren’t doing well. Of course you can’t send them out all the time before they pass, but I would think you’d have to call for more services if they were crashing.

[Cowboyardee]

First off, I'd recommend checking texas state laws, on the off-chance that any laws on the books or your state practice acts specify how a patient must be pronounced in your state.

Second, assuming no laws already address this, a facility policy should be addressed immediately. Perhaps an MD can call an end to CPR over the phone. Perhaps a checklist of criteria can be made. I would suggest addressing this question to your higher ups in writing ASAP.

All that is to say that calling an end to CPR as a nurse on the basis that you've been doing CPR for a long time and someone on allnurses recommended it sure doesn't sound like your butt is adequately covered to me.

Putting that aside, the answer to the question of when is it best to call an end to CPR is that it depends entirely on the circumstances. Whether or not the code was witnessed, the patient's comorbidities and age, the presence of reversible causes, the availability of treatments for those reversible causes, etc - all these things factor into the decision. A patient with few comorbidities and ecmo waiting might survive an extremely long code with relatively few long term effects, while a patient whose throat cancer has finally eaten through their carotid artery causing them to bleed out would experience literally zero benefit or chance of survival from CPR, no matter how brief.

[Gingeriffic]

Only an advanced provider can call a code. This seems wild to me that this discretion is left to ?nurses and the rest of a code team??

I’m pretty sure in situations like yours, you can get provider guidance over the phone and that would allow the verbal instructions of calling it. Hopefully you will soon have the option of telemedicine, which we’re seeing more and more for rural facilities.

[TwoLayi, ADN, BSN, RN]

From Texas BON

"Texas Senate Bill 823 (1991) amended Section 671.001 of the Texas Health and Safety Code and gave RNs the legal authority to assess a patient/client and make a determination of death, unless the pronouncement is clearly prohibited under the Health and Safety Code (such as when an inquest is required). The bill specifically requires the RNs employing agency/facility to have written policies jointly developed and approved by the nursing and medical staff to direct the practice."

HEALTH AND SAFETY CODE, TITLE 8. DEATH AND DISPOSITION OF THE BODY

SUBTITLE A. DEATH, CHAPTER 671. DETERMINATION OF DEATH AND AUTOPSY REPORTS, SUBCHAPTER A. DETERMINATION OF DEATH

Sec. 671.001. STANDARD USED IN DETERMINING DEATH. (a) A person is dead when, according to ordinary standards of medical practice, there is irreversible cessation of the person's spontaneous respiratory and circulatory functions.

(b) If artificial means of support preclude a determination that a person's spontaneous respiratory and circulatory functions have ceased, the person is dead when, in the announced opinion of a physician, according to ordinary standards of medical practice, there is irreversible cessation of all spontaneous brain function. Death occurs when the relevant functions cease.

(c) Death must be pronounced before artificial means of supporting a person's respiratory and circulatory functions are terminated.

(d) A registered nurse, including an advanced practice registered nurse, or physician assistant may determine and pronounce a person dead in situations other than those described by Subsection (b) if permitted by written policies of a licensed health care facility, institution, or entity providing services to that person. Those policies must include physician assistants who are credentialed or otherwise permitted to practice at the facility, institution, or entity. If the facility, institution, or entity has an organized nursing staff and an organized medical staff or medical consultant, the nursing staff and medical staff or consultant shall jointly develop and approve those policies. The executive commissioner of the Health and Human Services Commission shall adopt rules to govern policies for facilities, institutions, or entities that do not have organized nursing staffs and organized medical staffs or medical consultants.