stopping a CODE

Does a nurse have the right to voice their opinion on when to stop a CODE?

Yes. Doesn't mean that the person running the code is going to take your advice. And you also need to take into account the age of the patient, how long the patient has been down, whether or not the family is present in the room and wants you to continue. I've spoken up before.

I made my opinion voiced last night when we were coding an LVAD patient. We paced her and she remained in asystole and no matter how much epi we gave, nothing worked. We couldn't do chest compressions because of the LVAD. I said we should stop. We are allowed to give our opinion, it's up to the doc to listen to it.

As a nurse you are required to be a patient advocate & therefore, obligated to speak up in this situation.

During a code everyone can become so focused on tasks, that they lose site of the patient they are working on. To speak up, using sound rationale, to stop the code is considered being a patient advocate.

I agree and coding a patient for over an hour is not always the best for the patient either. I've been in codes where we stopped 22 minutes in. The patient was in V-fib, wasn't perfusing, shocked him at least 7 times, he was purple by the time we called it. There has to be a point where you say, ok enough.

The question always going through my mind is "what am I bringing back". If it isn't the potential for quality of life I speak up very early in a code and do everything I can to get the family in the room and stop.

Please don't ever hesitate to speak up or even say to the family- at anytime you wish us to stop, please say so.

That is true. And I haven't ever seen a patient who was down for more than 10 minutes come back with all of their faculties intact.

At our hospital the residents are usually running the codes (as supervisor I help run with them). If the code lasts a long time, they will often ask if anyone has any objections to stopping the code - if they fail to ask after what I consider an appropriate time, I will usually whisper to them if they feel we are succeeding in helping the patient?

A lot of times I've had nurses object to continuing a code whether it be based on age, or disease progress or whatever. Their objections are always taken into consideration. Sometimes we will stop, other times we continue to give family the time to come to an understanding that their loved one is not coming back.

If you know what is going on with the patient and understand how codes work - by all means speak up.

Pat

The last one we had I just asked the doc if he wanted us to continue. The pt had been down quite awhile before arriving to us, had no rythm, & was purple in color. The doc finished talking w/ the family and then we stopped. We can always give our opinion but the doc makes the final call.

That is true. And I haven't ever seen a patient who was down for more than 10 minutes come back with all of their faculties intact.

And that is why I would want you to stop the code on me after 10 minutes. Too bad Ohio does not allow me to put that in my living will.