I don't have quite the same scenario, but I understand your concern. I work in LTC and we have some 90 year old pts who are full codes. When I do the initial care plan meeting (yes, I'm an LPN who does MDS', writes care plans
, and does the care plan meetings) with the family, I'm always sure to discuss code status and what that entails. When I explain the being a NO code in our facility means that we won't do invasive procedures and won't start CPR if their loved one is found without a pulse/resps. When the family understands that the patient will still receive quality care-antibiotics, pain meds, cardiac meds, etc., etc., -they usualy want to change the code status to DNR. The few that still want their loved one to remain a full code, for whatever reason, are informed that any acute change that the nurses think may lead to cardiac arrest will result in their loved one being sent to the hospital.
In the setting I'm in, it's the nurses job to speak with the families regarding these matters, especially since the physician is in the facility only once a week. The physician will talk with the family if necessary but he's responsible for 100 patients just in our facility, so there's no way he could keep up with everything, especially with all the admissions and discharges.
Upon admission, the social worker gets an original code status, and then we follow up. So many things that used to be only in the doctor or RNs realm are becoming important for LPNs to be able to discuss. Of course, you can always bump it up to the RN if needed!