Slow Codes

[karenna]

Just wondered what kind of response I might get from this title.

Yes---I was a part of several on the night shift. They usually involved 80+ year old people with terminal illnesses who had idiot families that wanted them coded aka tortured before they went to Jesus.

[ChristyMNOP]

Its an actionable offense and could be considered criminally negligent. I do think more people should be made dnrs but we are not the deciders of that.

[Dolce, RN]

Nursing is considered, according to recent polls, to be the most ethical profession. I like to think that we are ethical because what we say we will do. That means that if someone is a 95-year-old full code with poor prognosis, cancer, etc I still plan on coding them appropriately with high quality CPR. Yes, it makes me upset when I see family member's interfering with the decision or physicians who don't properly explain actually what CPR involves and the chance that they may not survive anyway. However, it is our responsibility to provide honest care for patients and their families. To me, a slow code is neither honest nor ethical.

[gracie05]

I think that calling the families "idiots" is ignorant. These families may very well be uniformed about how traumatic coding someone can be, or perhaps, they just see their mother, or husband or wife, etc. in that bed and cannot bear the thought of letting him/her go yet. I understand how frustruating it is to have patient with a terminal illness a full code. I work in MICU/SICU and see it all the time. So, I guess what I am trying to say is that I think it is an unethical practice.

[canoehead, BSN, RN]

At one point I cared for a terminal patient with a DNR. All family was in agreement with this, and it was in writing. The doc at the time asked the patient's son if he wanted a breathing tube put in, and explained how it was different from a full code. Son was too upset to process the information. Vital signs showed she would probably die within the shift, perhaps a day later if intubated. He went to the phone to speak with his sisters, and they all agreed to let her go. But every time he came back to the bedside he couldn't bring himself to actually make that call, and would discuss it all again, then go back to the phone. He called them four times, reported the same decision each time, but couldn't follow through. When the docs changed shifts the new MD wanted to do a full resuscitation and workup. I asked him to hold on and explained the issues that the poor son was facing on his own. So we did an "almost" code...gently, and kept her alive until other family members could arrive and be together.

Yes, there were communication problems with the doc not wanting to say outright that she was going to die that day, not in a few weeks as they had thought. We sincerely tried to help that poor man, but sometimes you just need your family to be there before you take the plunge. His mum's last day was not a scramble of wires and blood, and compressions. I like to think that a slow code was the right choice in that case.

[txspadequeenRN, BSN, RN]

i could tell y'all some stories about geriatrics and codes or even better hospice and codes...

[canoehead, BSN, RN]

Yes, what the patient requests is sometimes the polar opposite of family wishes. If the two can't come together I still know where my loyalties lie.

[suanna]

This used to be an official policy at my hospital- The patient would have a written "slow code " order. Someone woke up in administration and got rid of this illegal atrocity. In the real world, sometimes coding a terminal patient is the only way to prove to the family that everything that could be done was done, even if the prognosis is very poor. In my 20+years of nursing I don't think I have seen many terminal patients that were aware one way or another being coded.

Personaly, if my family will feel more comfortable with my passing if the docs and nurses do a little ACLS practice on my lifeless body, I am more than willing to be of service.

[nurse4theplanet, RN]

what do you mean by slow code

[canoehead, BSN, RN]

That's when you call a code, but you do everything slowly. So you discover the patient and walk calmly to the nurses' station and ask for assistance assessing the patient, the two of you determine that he/she is indeed dead, you start setting up the equipment you'll need while he/she walks back to the phone to call the operator. By the time the equipment is ready, and the code team has arrived, the patient is developing lividity. We provide excellent sedation for the upcoming procedures, and the doc intubates, bags, we get a line, and shoot some drugs in. (treating the chart, not the patient)

Been in nursing twenty years, and though there have been many patients I've sworn needed a slow code I have never initiated one beyond what I described above. I have seen EMT's drive in with a "code in progress" without compressions, but that guy was already in rigor. The "code" was for the drunken and angry family members who had threatened our guys on the scene. He was deader than a cold codfish.

[nurse4theplanet, RN]

I can understand the rationale for first responders who may happen upon a patient who has been dead for several hours or longer for liability issues. But to do this for a pt who is currently under the supervision and care of the hospital staff seems unethical to me. While I certainly do not agree with many family's decisions to rescuscitate their dying/terminal loved ones, I still do it. Promptly and correctly....until the doctor calls the code. I separate myself and my beliefs from the situation.

[MarySunshine]

I think coding someone who has requested to not be coded is unethical. Of course, you have to agree to do it by law, if that's what the family requests once the patient can't speak for him/herself.

But unfortunately, it's totally illegal to do a slow code.

So, I feel like I'm pretty much going to hell either way.