Levels of Code Status

[cardiac.cure03]

I'm just curious as to how other nurses in the country deal with different levels of code status'. In my hospital (in Ohio), our patients are either a full code, DNR-CCA, or DNR-CC.

Full code: I'm sure that we can all agree on what a full code means!

DNR-CCA (Do Not Resuscitate-Comfort Care Arrest): You continue to treat the patient as a full code up until time the patient cardiac arrests. If the patient cardiac arrests, you stop all medical treatment. Unless the physician specifically indicates on the code status order form, the patient will be intubated. However, I find that in my unit, most patients who are a DNR-CCA are also a DNI (Do Not Intubate) which can be indicated on the form.

DNR-CC (Do Not Resuscitate-Comfort Care): The patient only receives care that promotes and offers comfort. Treating fevers if patient is uncomfortable, ativan/morphine, medications to dry up secretions, etc.

I am curious as to how many nurses are familiar with these levels of different code status'. It seems like they have phased out a simple "DNR" and in the hospital, at least, they make the physician clarify if the patient is a DNR-CC or DNR-CCA.

Any input?

[Meriwhen, ASN, BSN, MSN, RN]

I would hope that any patient regardless of their code status will receive comfort care, and I'm a little alarmed that comfort care has to be specifically designated. Last I checked, DNR doesn't mean "do not treat pain" or "ignore dyspnea."

I'm in psych so the definition of most of my codes are far different :) We do have some DNR patients, but for the most part patients haven't specified a status upon admission, so we treat them as a full code unless they decide otherwise and let us know.

[sapphire18]

This seems to have been a big issue lately. I LOVE the idea of a "DNR-CCA" as it seems a lot of people think that DNR means "do not treat." So being treated as a full code up until arrest is perfect; it's what I think a DNR should be. Also for us, unless indicated otherwise, a DNR is also a DNI. They can also specify DNI only, chemical code only, how many rounds of drugs to push...pretty much everything you can imagine...although most of these options will not keep the patient alive, it makes the family feel better that they are doing something.

I also feel that comfort care in my current facility is not handled properly. They do not always get pain or anxiety meds, many people do not check temps to see if the pt needs tylenol for a fever, etc. We are working to come up with new policies regarding comfort measures only.