Should families be present during a code?

[paperdreams]

Recently we had a code on our floor where the 8 family members were asked to step out at the start. The patient was an 85 year old cancer/ heart patient that we had had multiple discussions with his family regarding making him a DNR. The family could not agree.

The poor man had deteriorated to 90 pounds, had a TLC, PEG, Foley, none-rebreather mask and had come in with multiple infected breakdown areas.

He finally gave in and we hade to "code" him.

The family, crying and carrying on in the hall caused quite a disruption on our 42 bed Telemetry unit insisting they had to be in the room to " be with him until the last second." His roommate and family was assisted out immediately.

The patient rooms are semi-private, and the hospital was built in the 1920's, so the rooms are not that big to allow all the equipment, staff...etc...

Believe me, this was one of those situations where we would have "walked around the floor a few times before finding him" if no one had been there, to give the poor guy a peaceful and dignified death.

We tried to have a staff member stay with the family right outside the door to give them an explanation, but they insisted on being in the room at the patient's side.

Unfortunately, we had to call security to take them to the day room where they stayed until it was all over and he was prounounced.

They were allowed in immediately after the gentleman was cleaned up a bit.

We are now getting flack back from administration saying the family should have been in the room. I disagree....

What's your opinion?

[canoehead, BSN, RN]

Eight people would never be able or allowed in a room at my hospital. If there was one reasonably calm person they could stay, but during a code is not a time for negotiations and exploring options. You need to make a decision as best you can and administartion has to believe you did the best you could with the situation you had.

[Tweety, BSN, RN]

Indeed it has been discussed here with a variety of opinions. Here is one discussion of many: https://allnurses.com/forums/f8/code-blue-family-bedside-298282-7.html

If your administration is supportive of family presence during a code then they must come up with some sort of plan and training. It works best when there is a designated staff person, primarily a chaplain, as well as staff preparation.

Obviously we all can come up with examples of how a family can be disruptive during a code. It's not for every single family. We have to use our judgement on who to let in and who to ask to leave.

To have a blanket policy that family can not be present during a code is not a good policy in my opinion.

[Babs0512]

I support family members being present for a code, perhaps not all eight of them, but picking a couple to come in with assigned staff person to explain what's going on and what we are doing to their loved ones.

Studies have shown fewer lawsuits when family's are allow in a code. They can "see" everything is being done that can be done. When the code is over, they "see" us treating their loved one humanly, cleaning them up, putting a pillow under their heads, giving them a blanket, etc...

Family members need a staff person assigned just to them. To keep them out of the way of resuscitation efforts.

Once in a while you get the hysterical family member or two, then we gently suggest they wait outside to help calm down - I've never had a problem so long as family isn't given attitude by staff.

If family is in the room, the typically comments or "jokes" that staff use to blow off steam have to be kept in check.

That's my worth.

[mpccrn, BSN, RN]

i've been in both situations......code with and without family present......we did things strickly because they were present that we would not have done if they were not......no, they should not be present during a code.....it's ok if resusitation is attempted prior to a full code so they can see things in a downward spiral but once the flat line occurs, they should be asked to leave......most get the idea themselves when they see a million people rushing the room. if they are interested in doing the best for their loved one, they usually WANT to get out of the way.

[woody62, RN]

I believe that those of us who support a family member's presence, during a code, support just that, one family member. And most of us support a staff member accompanying that family member. I don't think that anyone supports every family member being allowed in during a code. And hospitals should have policies, in place, to control uncontrolable families.

Woody:twocents: