My TCU CPR policy - page 3

Even for full code pts, my TCU CPR policy is not to do CPR if the pt is determined to be dead. The TCU protocol qualification for being dead is no pulse and no response to stimulus. (a person... Read More

  1. by   LaughingRN
    Quote from Esme12
    I am uncomfortable with this.....that policy essentially says let everyone die. PM me their name and I'll report them. At least there will be an investigation to find out this is true and understood properly. This is a TCU not a hospice unit.....I'd go to the media now. This policy is a problem.

    NO AEDs? Wow this place needs to be closed down. go to the joint commision web site and file a complaint. Here is the link. The will investigate. Call the state.

    Thanks for saying this.

    I fully support you passing on the information to Esme12 so she can report this.

    Absolutely disturbing
  2. by   Enthused RN
    Quote from unsaint77
    ... as determined by a licensed professional.
    Maybe they define licensed professional as a MD or paramedic? Those are really the only 2 who can legally declare someone dead, right? As a previous poster said, I would clarify with your facility on what exactly they mean and talk through some scenarios with them. For me, I would start CPR until a MD or paramedic gave the declaration.
  3. by   Epic_RN
    Having just gotten my ACLS certification, this greatly disturbs me. Per ACLS guidelines, you do not attempt compressions only if there is a DNR or rigor mortis present. In my facility, we attempt resuscitation regardless of rigor mortis being present unless there is a DNR.
  4. by   LaRN
    Quote from unsaint77
  5. by   tothepointeLVN
    I would have to believe that policy refers to someone that is not only merely dead but really most sincerely dead. When someone is most sincerely dead you know it.
  6. by   PetsToPeople
    Quote from AnonRNC
    "Obviously dead" needs to be defined? How can you tell the difference between 3 minutes and 30 minutes dead?
    I agree, if "obviously dead" was added to a policy, it would have to be defined, otherwise you would be opening yourself up to major liability because the facility would be able to pass the buck onto the nurse.
  7. by   PetsToPeople
    Obvious signs of death include dependent lividity aka livor mortis (20min-3hrs), rigor mortis (1-3 hrs post death)...anyone think of other examples? Possibly obviously low temperature that is felt by hand but that may be too subjective...
  8. by   sckitty
    Props to the commenter that said she would report the facility!
  9. by   sckitty
    "Clarify" means you go up to the DON or administrator and say, " I have read the policy on this over and over. It seems to me ...(liability, DNR, responsibility,blah, blah) Can you CLARIFY this for me?"
  10. by   wooh
    I think "obviously dead" is what the policy was trying to say, giving things like no pulse. Unfortunately, the criteria listed, such as no pulse, are the criteria for DOING CPR. I think the policy was probably written with good intent, just badly done.
  11. by   hherrn
    hhern, can you be more specific as to what you think I got wrong? Everything you said is EXACTLY what I know and what I think. Of course no pulse means no breathing and no pain response. Of course everything about this ridiculous.

    My bad. I misunderstood you to believe that this policy allows fo chest compressions in some instances, which it it does not. (I understand that in a normal setting, the only time chest compression is needed is in the scenario described in #4)

    The policy, as it reads, prohibits chest compressions at your facility.

    I doubt this is intentional. You suspect some financial motivation, but that seems unlikely. God forbid any nurse actually follows this policy, the institution would incur a huge financial liabilty. And, I suspect the nurse would be liable as well. Look at it this way: If your institution had a policy of treating hypokalemia with a 1000 meq rapid push of K, you would be expected by your nursing board to not follow the policy.

    In all likelyhood, the intention of this policy is to avoid un-needed CPR on coprses. A reasonable goal. I suspect the policy was written by an idiot. They are out there. And some of them are in charge.
  12. by   jlivermore
    If we are "theoretically" using lividity or rigor mortis as a determining factor here for a pt. who is "obviously dead" What are the chances here that you are going to find that person in this state if you are rounding and your CENA's are rounding within the required time frames? In my opinion, if you are doing your job, anyone with a full code should get CPR. Please keep in mind that I work in a small facility and we rehab our pts in the same area we house our acute patients. I have been called to pronounce a death in our long term care unit, where the person is "obviously dead" and rigor has set in, but in the end, these people are expected to pass and already have a DNR in place.
    I as an RN, would never ever follow this policy. Unless I know this pt. is a no code, they are receiving CPR from my team until a doctor calls the code.
    This policy needs to be seriously revoked or rewritten. I would, also, report this.
  13. by   jlivermore
    Also, all pt. within the facility be it an acute pt, a rehab pt. or a resident will be coded by the hospital staff: ER doc, RN, respiratory, etc...