Ran to my first code alone...

[WWRN]

so, i ran to my first code alone last evening.... the adrenaline was flowing and i was feeling pretty good when i was the first one there after the resident and i started cpr, was pushing epi and atropine, and really participating. we intubated, drew a femoral abg, etc... and then it happened...

[color=#483d8b]the other icu nurse recognized the patient and said 'he was a dnr on our floor.' she checked the chart and sure enough the man was a full dnr.

[color=#483d8b]i feel pretty guilty/angry today. guilty for not checking myself and putting the poor man through all of that.

[color=#483d8b]angry that there was a huge communication breakdown in the system so that the bedside nurse's kardex said this man was a full code when the code sheet in the chart said exactly the opposite! :angryfire

[color=#483d8b]how do the rest of you identify pt's who are dnr? i think our system needs an overhaul and i'm in the mood to take action. i don't want to ever feel this way again!

[color=#483d8b]thanks for listening! :heartbeat

[XB9S, BSN, MSN, EdD, RN, APN]

If you were unsure or unaware at the time of cardiac arrest it is appropriate to start resusciation. When the status of the patient becomes known it is then appropriate to stop resuscitation.

I see no ethical issue here, you worked with the information you had at the time and adjusted your care when further information became available.

[ChristineN, BSN, RN]

The same mistake happened when I did my ICU rotation in school, a DNR was coded but ended up dying anyway. Is there someway there could be signs or something above the bed so in an emergency you would quickly be able to tell if the pt is a DNR or not? In an emergency, if you don't know the pt, you don't have time to flip through the chart.

[mama_d, BSN, RN]

We use purple DNR bracelets and write the appropriate code level on them...medical management, comfort only, DNI, no CPR, etc.

I always double check my patients' code status against the chart and verify bracelet placement with my first rounds, just to avoid this kind of situation...it happened to another nurse right after I started my career, and I took the opportunity to learn from that mistake.

[XB9S, BSN, MSN, EdD, RN, APN]

In answer to your question, we identify our DNAR patients with a big yellow form in the patient notes and then this is handed over shift by shift.

[mpccrn, BSN, RN]

we rely on the bedside nurse who is calling the code or the rapid response team....it was her error, not yours IMO

[uscstu4lfe]

i only double check the chart if it's a DNR order (because making someone a DNR when they're really a full code would really suck). If the kardex says they're a full code, I just assume that they are and go about my business.

I also agree that there is a break down in communication - big time. For example, during report I will be told a patient has an allergy to one thing, the kardex will say another, the MAR will state something else, and the chart will reflect something different. No one really cares enough to fix the problem, but I know they will change it when someone ends up coding or dying for this.

[racing-mom4, BSN, RN]

Our DNRs wear a yellow bracelet and there is also a big yellow star on thier chart and a yellow V line on thier tele. Also that is the one of the 1st things mentioned in report, Age, Dr, Code status.

It is also on the front of computer charting. We have put all these in place because of the exact same scenerio you described.

[oramar]

Yeah, the alternative to what you did is to be frantically leafing through a chart checking code status. Not your fault, hospital has a system problem.

[Pudnluv, ASN, RN]

We have a big yellow dot on the outside spine of the chart. It is also noted on the Kardex and the Molst form we use is bright pink and sits in the front of the chart. I wish we would start using DNR bracelets and there has been some discussion of that. I too, called a core on someone who was a DNR and got my fanny chewed out. We stopped as soon as we knew. Now, I always make sure before calling the core.

[locolorenzo22, BSN, RN]

We use a bright orange sticker on the spine of the chart that says DNR, we place a blue band on them that says DNR, and their name above the bed is written in red. I agree, something about the system needs to be fixed.

[DorothyAnn0403]

The SAME exact thing happened to me last night. Luckily i remembered from report that the woman had become "care and comfort." Clicking in my head was that Full Code and Care and Comfort don't go together.

Booked it down the hall and had my answer in 2 seconds flat when i yelled for help.

Would've felt horrible coding the poor woman. :-(

But there's nothing we can do, the system needs to be changed.