91yr old, end stage everything, family wants "everything" done despite multiple talks with MD's regarding what exactly is their expectation and how its not going to happen quite that way.. So when the pt coded, we got the family all close and personal with the code and all the rib breaking so that they could see that indeed we are doing "everything" .
Now they want to sue the hospital for battery and ABUSE because we broke the pts ribs during cpr....
If I had my way anyone over a certain age, and anyone with certain diagnosis would automaticaly be DNR and they would have to opt in to be full code.
I can't agree with this at all. When the feds get involved in healthcare "requirements," it's never good. I have also seen situations where a full code on a terminal patient has been decided due to life circumstances, such as the patient wanting to hold on until a baby is born or a wedding or something of that sort. I would, however, support a law that says when a patient has decided upon a DNR that the POA can't override it in the 11th hour.
It is time for the American Heart Association and ILCOR to study the outcomes of CPR in patients with osteoporosis and advanced age.
A simple dexa scan of the hip or wrist should be required to be a full code in patients with osteoporosis.
It is barbaric to do CPR on an elderly person and fracture their ribs. I refuse to do it.
Nope. I have osteopenia at age 43 due to my cancer treatment and TVH-BSO. I just can't support any law that supports taking the code status decision away from the patient. Taking it away from the POA when a DNR was decided upon by the patient is something I can get behind, though.
Nope. I have osteopenia at age 43 due to my cancer treatment and TVH-BSO. I just can't support any law that supports taking the code status decision away from the patient. Taking it away from the POA when a DNR was decided upon by the patient is something I can get behind, though.
I said osteoporosis and advanced age, not osteopenia and adulthood.
There is a big difference.
My second sentence did say osteoporosis and I apologize for being unclear.
I am opposed to inflicting injury, pain and suffering upon frail elderly people of advanced age with osteoporosis.
I feel the outcomes of doing chest compressions in this population should be researched by ILCOR and AHA.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
I can't agree with this at all. When the feds get involved in healthcare "requirements," it's never good.
First nobody said anything about the feds. Second what we are doing now is about as bad as it can possibly get.
I have also seen situations where a full code on a terminal patient has been decided due to life circumstances, such as the patient wanting to hold on until a baby is born or a wedding or something of that sort.
How is that in any way related to code status? Code status only takes affect AFTER the patient is dead. If a person with a terminal diagnosis dies and is coded how is that going to matter to the wedding or baby being born? Have you seen what shape terminal patients who have been coded are in?
I would, however, support a law that says when a patient has decided upon a DNR that the POA can't override it in the 11th hour.
How is that in any way related to code status? Code status only takes affect AFTER the patient is dead. If a person with a terminal diagnosis dies and is coded how is that going to matter to the wedding or baby being born? Have you seen what shape terminal patients who have been coded are in?
As a matter of fact, I have. He was coded twice in ICU and intubated. Eventually, he went home for a time before he came back, coded and died. He was stage four with mets to liver, brain, and bone, tube fed, pleasure feedings, pain control when he finally got to me on the floor. Perfectly alert and oriented. Coding in the ICU gave him time to see his child graduate from high school. It was *his* decision, which was the point of my post. It's the patient's decision, and it should not be anyone else's based on some federal regulation regarding code status.
My feds statement comes from the logical extension of who would be responsible for instituting the requirement you posed? No hospital is going to do it on its own, so therefore it has to be a state or federal requirement.
ETA: I reread your comment, and I see that you said, auto DNR with full code opt in. I misread, so I'm arguing something you never said! I apologize.
However, I still don't agree because what if a patient comes in that doesn't have the immediate capacity to opt out but fits all the other criteria you mention?
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
A
s a matter of fact, I have. He was coded twice in ICU and intubated. Eventually, he went home for a time before he came back, coded and died. He was stage four with mets to liver, brain, and bone, tube fed, pleasure feedings, pain control when he finally got to me on the floor. Perfectly alert and oriented. Coding in the ICU gave him time to see his child graduate from high school. It was *his* decision, which was the point of my post. It's the patient's decision,
Its a bad idea to make policy based on one example.
and it should not be anyone else's based on some federal regulation regarding code status.
My feds statement comes from the logical extension of who would be responsible for instituting the requirement you posed? No hospital is going to do it on its own, so therefore it has to be a state or federal requirement.
Oh I don't think so. Is it a federal regulation that a patient complaining of chest pain get an EKG? No but it is the standard of care.
There doesn't need to be a federal regulation. All we need to do is stop paying for such care and policies with pop up.
A standard of care where no resus is done unless the patient says otherwise WOULD require a state or federal regulation. It's too big a change--a life or death change--that could not be instituted without a lot of vetting among the public who would be at the mercy of such a decision.
In addition... Yes, it's a bad idea to make policy on one anecdote. However, the standard of care you are posing (that I thankfully misunderstood) is too far-reaching and absolute to account for the situation I described.
The one change that could make the bigger difference is that patient wishes are written in stone, unable to be changed by the POA. That's exactly the regulation needed to prevent what happened in RNsRWe's first post in this thread.
I really want to know if chest compressions even work in a frail elderly person with severe osteoporosis or are we just fracturing the ribs and even the vertebrae?
This needs to be studied by AHA and ILCOR so that patients and families can be given factual information in order to make an informed decision.
If there is no benefit to the person of advanced age with severe osteoporosis this should be part of the algorithm.
I also believe that when people enroll in Medicare a notarized advanced directive should be mandatory and updated yearly in order to continue to receive Medicare benefits. Payment would be made based on the content of the pt's advanced directive.
I am tired of adult children who want to keep a parent alive forever so that they can have a free place to live and take the parent's social security and retirement funds.
I also believe that when people enroll in Medicare a notarized advanced directive should be mandatory and updated yearly in order to continue to receive Medicare benefits.
When the pt becomes cognitively impaired and unable to renew his advance directive, his last advanced directive will be considered as his current advanced directive.
This would enable correct use of medicare funds, allow physicians to practice medicine and allow a natural death according to the individuals wishes.
Pres. Obama has said many times that the majority of healthcare spending is in the last three weeks of life for ICU care.
It is unconscionable to trach a 90 year old who was trying to die of pneumonia or other natural causes and send him to an LTACH just because a relative said "do everything" and the MD is afraid of a lawsuit.
Notarized advanced directives would make family members requests irrelevant especially if they are linked to reimbursement.
Hospital administrators would start caring about medically futile treatment if it meant they would have to absorb the cost.
Families could not insist on medically futile treatment unless they were willing to pay for it up front.
When the pt becomes cognitively impaired and unable to renew his advance directive, his last advanced directive will be considered as his current advanced directive.
This would enable correct use of medicare funds, allow physicians to practice medicine and allow a natural death according to the individuals wishes.
Pres. Obama has said many times that the majority of healthcare spending is in the last three weeks of life for ICU care.
It is unconscionable to trach a 90 year old who was trying to die of pneumonia or other natural causes and send him to an LTACH just because a relative said "do everything" and the MD is afraid of a lawsuit.
Notarized advanced directives would make family members requests irrelevant especially if they are linked to reimbursement.
Hospital administrators would start caring about medically futile treatment if it meant they would have to absorb the cost.
Families could not insist on medically futile treatment unless they were willing to pay for it up front.
YES!!!!!
You say it so much better than I ever could.
I do believe it comes down to money, harsh as it may sound, but if someone who has no chance of recovery decides they want to be a full code just a little longer so they can dance at someone's wedding (or whatever), would they still insist if they were the ones to pay?
dudette10, MSN, RN
3,530 Posts
I can't agree with this at all. When the feds get involved in healthcare "requirements," it's never good. I have also seen situations where a full code on a terminal patient has been decided due to life circumstances, such as the patient wanting to hold on until a baby is born or a wedding or something of that sort. I would, however, support a law that says when a patient has decided upon a DNR that the POA can't override it in the 11th hour.