I have a MD who just likes to be contentious. This issue has never come up before but came up this week. We had a code blue in the waiting room (primary care clinic) for a patient's family member. We stablilized the patient until EMS showed up and updated EMS on vitals, etc.
Afterwards, the MD said we shouldn't be providing this care. I said we should and always have. He then asked, "well, how do we document the care we provided" and I was stumped. Normally, we've just recorded it on a piece of paper and provided a timeline to EMS.
What do you all do for code blue for non-patient in a non-hospital setting where they can't/won't be admitted? Thanks!
Oh, and I work with a MD that has only been sued once for malpractice in his 30 years of practicing and it was by family of random stranger at a restaurant who was choking and he tried to Heimlich and failed.
Depends on where you live. This LPN can pronounce. The LPN might even know the code status of the patient on the ground that you are wanting to perform CPR on.
stand corrected on that,however in az as far as I read on BON, an LPN cannot do an actual assesment,but collect the data to be provided to RN/MD, then how would an LPN be able to pronounce death with her assesment? To do nothing IMHO is ignorant and hugely liable, why wouldn't medical staff do everything within their training to help somone.? I do see that lpn pronouncement has been a topic on here in the past, will look at those threads to educate myself on that. Thanks
Specializes in Complex pedi to LTC/SA & now a manager.
Everything within scope is unrealistic. Do they have a defib, cardiac monitor, xray, fluoroscope, ACLS drugs, IV set up, intubation set, ventilator, full patient history? Most offices have few if any of these items
Therefore, BLS is the most medically prudent course of action. Check for responsiveness , call 911, start CPR compressions only if no mask or barrier is available.
stand corrected on that,however in az as far as I read on BON, an LPN cannot do an actual assesment,but collect the data to be provided to RN/MD, then how would an LPN be able to pronounce death with her assesment? To do nothing IMHO is ignorant and hugely liable, why wouldn't medical staff do everything within their training to help somone.? I do see that lpn pronouncement has been a topic on here in the past, will look at those threads to educate myself on that. Thanks
LPNs in my hospice company pronounce all the time. And they sure as heck do assessments. They can't do the initial, but they can do subsequent ones as delegated by the RN. That's my company's policy, anyway, and I hardly think they'd write and maintain a policy that has LPNs regularly practicing out of scope.
stand corrected on that,however in az as far as I read on BON, an LPN cannot do an actual assesment,but collect the data to be provided to RN/MD, then how would an LPN be able to pronounce death with her assesment? To do nothing IMHO is ignorant and hugely liable, why wouldn't medical staff do everything within their training to help somone.? I do see that lpn pronouncement has been a topic on here in the past, will look at those threads to educate myself on that. Thanks
So are you saying that if you know the code status of someone you find down and don't do everything within your knowledge base, it is ignorant? I've met a patient that was a DNR that was brought back by someone who thought they knew best. Never met an angrier human being in my life.
So are you saying that if you know the code status of someone you find down and don't do everything within your knowledge base, it is ignorant? I've met a patient that was a DNR that was brought back by someone who thought they knew best. Never met an angrier human being in my life.
DNR is totally different, if you don't have DNR on record/in hand and you donot provide basic care yes basic care as I stated in original statement, then absolutely ignorant and wrong. In situation that was stated in my original post we still worked on the guy,until all we could do was done, to no avail, would rather have tried and know I tried than not try at all. Why wouldn't you? As stated in original post person in question was a maintenance man working at facility, not a patient, so unless he had a DNR in his pocket, damn right you do everything able to help. This thread was about a person on property, not a patient with a DNR, I would not if I knew for a absolute fact the person had a DNR, if a person sitting at a bus stop goes into cardiac arrest, would you not as a medical professional do basic care? Do you call a number you find in their wallet and ask if they have a DNR order?
LPNs in my hospice company pronounce all the time. And they sure as heck do assessments. They can't do the initial, but they can do subsequent ones as delegated by the RN. That's my company's policy, anyway, and I hardly think they'd write and maintain a policy that has LPNs regularly practicing out of scope.
So when you do a pronouncement assesment you go ahead and call the funeral home and family on your own with no call or advisement from an RN or MD without any further verification?
Documentation should NEVER dictate whether or not you assume care for someone. It should back what you did for the patient. Sorry I can't assume care because I can't document on you? Ridiculous. Keep a written copy of the event and interventions and make a physical chart for the person and store in your medical records.
Also read up on The Good Samaritan law in your state. It may protect you from any kind of negative aftermath. Technically it wasn't a "checked in" patient so you may have coverage under that law.
In Oklahoma we (citizens as well as licensed professionals) can provide basic care to anyone with threat to their life and not fear of being sued for assisting. So I, as an RN, can provide basic care to non-patient if needed until EMS arrives and not be afraid of someone suing me just because I am a nurse. I am not exempt from that law just because I am a nurse because that discriminates. It applies to ALL citizens.
Every state is different though so do research thr law for your state. Weather or not they were inside your clinic they were still a non-patient at thre time of occurrence so I think this law would apply to protect you.
LPNs in my hospice company pronounce all the time. And they sure as heck do assessments. They can't do the initial, but they can do subsequent ones as delegated by the RN. That's my company's policy, anyway, and I hardly think they'd write and maintain a policy that has LPNs regularly practicing out of scope.
Hospice has different rules for pronouncement of death.
I as a hospice RN can't pronounce death on someone who is NOT a hospice patient.
Two different things.
Here in rural California, it used to be that the coroner was called to pronounce. Do you know how long that would take? And the nurse had to stay in the home until the coroner got there. Very unwieldy system. Glad they changed the law for Hospice.
Good Samaritan laws (to my knowledge) do not protect the provider if the provider is currently working and the individual is within a medical facility, including a primary care office.
BostonFNP, APRN
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Oh, and I work with a MD that has only been sued once for malpractice in his 30 years of practicing and it was by family of random stranger at a restaurant who was choking and he tried to Heimlich and failed.