Palliative/Full code

Many of our palliative care patients are full code. Many of our hospice patients are also full code. Usually by the time that they are near death, assuming their decline is not abrupt, they will have a DNR in place, but not always. Acceptance is a process, not an event.

Dear fellow nurses,

Is it possible for patients on palliative care to be Full code. I was told that all palliative care pts are DNR but, I think I have read somewhere that such pts can also be full code.

Yes, palliative care and hospice patients can be full code.

In some states, it is considered illegal to bias against hospice admissions, based on code status. Thus, you cannot force someone to become a no code to order to receive hospice services.

full codes are perfectly acceptable, and becoming more common.

many pts want to stay alive until all options have been exhausted.

leslie

There are many patients full code but many times this is due to lack of knowledge on the patient's part or the family's part. Counseling for the patient and family together on admission or on the initial case manager's visit should include this hard question: What comes after his/her CPR?

I usually explain to them that I am willing to do whatever they decide, but I want that decision to be the right one. It can be very traumatic for the family to see CPR being done on the patient for even 2-3 minutes and I have gone for 10.

Let them know that after CPR compressions, the patient will still have the same terminal dx, along with some very painful broken ribs that can't be mended and will hurt with every breath.

Hospice counseling should be ongoing to prepare patient and family for the inevitable. If this is being done, eventually the family will sign the DNR/DNI. Afterwards, they will need your assurance that they made the right decision. In some cases a patient can pull out of a crisis after CPR, but most are not hospice patients.

Jeff