Revived when there was a DNR/AND code status

[ambersky004, BSN, RN]

There was this experience that I will never forget in my nursing career.

Patient N came back with Afib with RVR. She converted to SR during shift change. The night nurse said she had episodes of chest pain. From her report she said the Pt N was more anxious that night. Pt N told the attending doc she wanted to go home and if she die of a heart attack she is fine with it. Her code status was DNR/AND. The heart doc said she needs stress test or cardiac cath but she's been refusing the cath the last time she was in our unit. I told the hospitalist she has been talking about her dead sister this morning and she wanted to "visit her?" She was teary-eyed. She denies any chest pain except last night. She denies any depression or thoughts of suicide to the attending doc.

So the attending doc told her the plan is she can go home with an outpatient stress test. Her 3 Troponins where elevated but trending down. Her series EKGs shows she had a previous MI and afib. WHile I was discharging another patient and educating her family and answering there questions, I saw our CNA wheeling our crash cart. So I look where he is going and I saw staff in a room. It is weird I did not hear the rapid response called. So I went and saw the RT doing CPR and ambu bagging. Our on call doc was in room and I told him she is a DNR. I saw the V-fib on the heart monitor and the heart doc asked me a question and told him she came in with Afib RVR. He asked me who is the doc I told him the heart doc but forgot she was not on duty that day so he said to call her and asked what she wanted to do.

So I called her and she said she will be right there. When I came back pt's attending doc was in there now and told them and the on call heart doc she is a DNR but she was defibrillated anyway or they still defibrillate her. The patient woke up and was a little upset, she was telling me, "that was my time." Or maybe because she fell unconscious and she might still be in a fog. I feel so guilty. I felt like i missed something like putting the DNR armband. Maybe that would change the doc's and team members intervention since I was not there immediately in the room. I swear i did not hear the overhead call. The attending doc was telling me, she's going to be pissed. So I scratch my head and the heart doc laughed at me, I think 'coz he looked me in the face but i was so shooked up it happened so fast 'coz the attending doc just talked to her that time and I just rounded her. Lastly, the patient is alive and agreed to get a cardiac cath.

In regards to ethical issue and patient's wish during hospital stay, did we break her code status? Will there be an issue? I always thought that atleast try to revive the patient when there is a chance. And probably that was the heart doc's thinking but the attending doc was on the patient's side. Ughhhh. What should I do the next time i encounter this situation? I know the patient is well-knowledgeable of her condition and her risks.

[Farawyn]

You absolutely did break her code status. Document your butt off, it may be lawsuit time.

[kp2016]

Honestly this is a very serious mistake. How it's handled will most likely depend on how angry the patient is and how your facilities policies are written. Given that you are bound to be hearing more about this I would start by writing a detailed account of exactly what happened, which staff were present and who said what. I would also review the hospital policy on DNR so you are clear on if you followed it or not before you make any statements about this incident to management/ HR.

The final advise I would give is do not under any circumstances throw yourself under the bus. You responded as soon as you were aware there was a rapid response on your patient. You informed the Dr that the patient was a DNR, the doctor is the one that continued the code when they should have immediately varified that there was a valid DNR and stopped the code as soon as it was confirmed as a fact.

[ambersky004, BSN, RN]

Will it be an issue for lawsuits if we break her code status and she is alive and she decided to get a cardiac cath? I should have documented that I told the rapid response team that she was a DNR/AND. But I did not. And the nursing supervisor let me fill up the cpr form. Should it be her?

[ambersky004, BSN, RN]

Honestly this is a very serious mistake. How it's handled will most likely depend on how angry the patient is and how your facilities policies are written. Given that you are bound to be hearing more about this I would start by writing a detailed account of exactly what happened, which staff were present and who said what. I would also review the hospital policy on DNR so you are clear on if you followed it or not before you make any statements about this incident to management/ HR.

The final advise I would give is do not under any circumstances throw yourself under the bus. You responded as soon as you were aware there was a rapid response on your patient. You informed the Dr that the patient was a DNR, the doctor is the one that continued the code when they should have immediately varified that there was a valid DNR and stopped the code as soon as it was confirmed as a fact.

Will it be an issue for lawsuits if we break her code status and she is alive and she decided to get a cardiac cath? I should have documented that I told the rapid response team that she was a DNR/AND. But I did not. And the nursing supervisor let me fill up the cpr form. Should it be her?

[Farawyn]

Will it be an issue for lawsuits if we break her code status and she is alive and she decided to get a cardiac cath? I should have documented that I told the rapid response team that she was a DNR/AND. But I did not. And the nursing supervisor let me fill up the cpr form. Should it be her?

It depends if the patient and family decide to file. You may hear no more about it.

Document your butt off, anyway.

[ambersky004, BSN, RN]

Honestly this is a very serious mistake. How it's handled will most likely depend on how angry the patient is and how your facilities policies are written. Given that you are bound to be hearing more about this I would start by writing a detailed account of exactly what happened, which staff were present and who said what. I would also review the hospital policy on DNR so you are clear on if you followed it or not before you make any statements about this incident to management/ HR.

The final advise I would give is do not under any circumstances throw yourself under the bus. You responded as soon as you were aware there was a rapid response on your patient. You informed the Dr that the patient was a DNR, the doctor is the one that continued the code when they should have immediately varified that there was a valid DNR and stopped the code as soon as it was confirmed as a fact.

Yes you are right. I told the heart doc and the team and also the hospitalist. I even asked my co-workers and they've heard that she is a DNR, "but why is doctor so and so continued? that's what i did not understand. Doctor so and so told doctor so and so that she's a DNR." So I talked to the attending doc and she told me that this is what heart doctor said.

[ambersky004, BSN, RN]

I know this was a huge mistake, didn't even documented that day. So i didn't get to sleep and keep worrying about it.

[kp2016]

Will it be an issue for lawsuits if we break her code status and she is alive and she decided to get a cardiac cath? I should have documented that I told the rapid response team that she was a DNR/AND. But I did not. And the nursing supervisor let me fill up the cpr form. Should it be her?

I'm a nurse not a lawyer but I don't imagine what the patient chooses to consent to now (cardiac catheter) will make any difference to the fact that the patients DNR was ignored. If I was you I would make an immediate late note in the chart detailing that you advised the doctor of the DNR status. If possible have someone else who was in the room also document that they heard this.

[ambersky004, BSN, RN]

I'm a nurse not a lawyer but I don't imagine what the patient chooses to consent to now (cardiac catheter) will make any difference to the fact that the patients DNR was ignored. If I was you I would make an immediate late note in the chart detailing that you advised the doctor of the DNR status. If possible have someone else who was in the room also document that they heard this.

Thank You.

[Farawyn]

I know this was a huge mistake, didn't even documented that day. So i didn't get to sleep and keep worrying about it.

Have you documented since?

[ambersky004, BSN, RN]

Have you documented since?

I did not since Saturday. Tomorrow, I will be back to work. Appreciate you for telling me about this. I was so tired and did't really care that day. Just want to go home. I feel a failure to my patient and didn't think about it 'coz I had to finish my documentation on a new admit and doing the med reconciliation. Now, I have learned things regarding this. All I am hoping for is she won't sue us.