LPN and Advance Directives? What if?

[Yule B. AyOkay]

I am a brand new LPN and will probably have many questions like this one, and I want to take the time to thank you for reading and any input you give.

I am worried that when I get a job that I may have a patient code, or walk in on a code, and not remember or know if they are DNR, DNRCC, or full code. I did ask in school and my instructors had all different answers for me, but it still left me unsure of what is the best thing to do.

Many said they would try to save their patient, and if the patient was a DNR then to take whatever repercussions (firing, lawsuit, loss of license) that may follow. A few said they would call another LPN or RN who knew the patient better and institute comfort care measures until their advance directives were known.

My questions are:

-Has anyone here been in a situation like this?

-What would/did you do?

-How can I better prepare myself for a situation like this/learn my patient's advance directives quickly?

Again, thank you.

[vintagemother, BSN, CNA, LVN, RN]

My facility marks the charts on the outside with a specific color to identify DNRs.

I also know exactly where to look to get the POLST form which has advance directive care measures to be taken on it.

Learn where to find that info at your facility.

[Esme12, ASN, BSN, RN]

Facilities are usually very clear about this and it will be given to you in report. Different states/facilities have different rules but it will be on the chart.

[ClearBlueOctoberSky]

Each facility is different. I work LTC and our current policy is that is the nurses responsibility to know what your patient's COR status is. Our charts are not marked, it is not handed to you in report, unless that status has been changed recently. It is not marked on our report sheets, and per our corporate policy, can not be included. That said, many nurses have their own "master" report sheet that they made where it is marked for easy reference. It is your responsibility to know where to find the MOST form and what it says.

It is one of the things that should be covered in orientation, and if it isn't, ask: "What do I do if?"

[systoly]

my suggestion:

go through the charts and look it up at each shift begin

it only takes a few minutes

if this info is given in report, i still wanna see it myself

don't trust stickers on the chart (may not be up to date)

a lot of times the off going nurse isn't quite ready for report

so this is a good time to do this

[Mn nurse 22]

If I walk into a patient's room and find them unresponsive I start my assessment, and ask any staff member to grab their chart do I can read their Advanced Directive, also gives me their diagnosis and a medication list to start making a plan of care.

[sallyrnrrt, ADN, RN]

mds nurse can print out a current code status, but may not be complete,

when i have a crisis of seriousness with a resident i give the folliwing comnands "get the cart and chart, what is the code status?"

i want the chart as if the code status is not known, they are kept in the very VERY FRONT of chart and only takes secs.....i want the crash cart just in case, ther are things to treat with but not necessarily to resusitate with, suction for aspiration, oxygen, etc......

i have done this for near 42years, it only takes secs to have correct information...... this is my action plan in acute care and LTC?

[Yule B. AyOkay]

Thank you all so much. :)

I will definitely make sure to ask when I find a job.

It was just nagging at me so much that I needed to ask. I would receive a 2-3 page report on my patient(s) made by my instructor that had all of the diagnoses, medications, advance directives, ect. Therefore, in clinical, all students were encouraged to stay out of the charts so we didn't get in the nurses' way. My school also was very strict about not removing the charts from the nurse's station for any reason.