Stopping a code w/o MD

If the SNF patient does not have a DNR order on his/her chart, the code continues until the EMS personnel arrive and take over. In the nursing home/skilled nursing facility setting, the floor nurses do not have the authority to stop a code once it has started. Only the paramedics can make the call to stop the code in this type of workplace setting since there are typically no physicians present in nursing homes.

I understand that the Nurses would not have the authority to stop the code but the family does not have the authority either?

I forget the exact wording but legally yes once CPR is started you should continue until you are exhausted, are in danger, or medical personnel take over. But regardless of whether or not the family had POA, even if they didn't, common sense with an ?obviously? frail elderly adult in a nursing home nearing the natural end of their life a code is called and family says please stop the code I say stop! What is the worst case outcome? The family is going to sue you because you didn't save their loved one? The police are going to investigate a suspicious death? We can argue legal precedent all day which unfortunately seems to carry greater weight than common sense!

The medical power of attorney (with papers in hand) has the same authority as the patient to stop any procedure. I would stop a code if they requested it.

In a LTC facility once a code is started it CAN NOT be stopped until the medics arrive and take over. Once the medic is there, it is his/her call, since they are now responsible for the patient. Even if the POA/person in charge of pts health decisions/family members are there and state they want it stopped..once it starts..it can't be stopped, the RN, house super, DON or ADON do not have authority nor can the demand that a nurse stop CPR once its started.

Now, that being said, a full code status may be changed at any time (with the exeption of once the code is started), by simply signing a DNR paper.

To be the devil's advocate, I'm sure this isn't the case in EVERY state, as each state is different.

Lost count how many states I've worked in, ER RN and EMS. All say the code continues until EMS takes over. Nurses can only stop a code in progress as brownbook stated, or on an MD's direct order. The RN unit manager let her title go to her head. EMS works under medical directors standing orders and often are in direct contact with an MD via radio. POA shoulda manned up and signed the DNR papers before the code.

I hate this sytem, but it's what the laws dictate. Despite POA, if one family member, even out of state, disagrees with stopping the code, you'll spend some "quality time" with lawyers. Once in court, it's always easier to defend acting in favor of life.

That must have been really, really, rough on that RN -- all that going on...

If the RN knew here scope of practice and the legalities of her position, as she is obligated to do, she could have remained calm and explained things to the family. Lacking a DNR order, resuscitation is required unless an MD directly orders it stopped.

I participated in a code in a Maine ER, with the POA present and protesting, because a relative in California was on the phone threatening legal action. In the end, metastatic brain cancer after a very long life took the decision out of mortal hands.

Both nursing and EMS personel take their orders from physicians. Neither is allowed to practice medicine. Important to remember in unusual circumstances.

If the pt. is a DNR per decision of the POA, the out of state relatives can protest till the cows come home, it DOES NOT change the legal standing of the POA to make a decision. Any legal grievance by a "relative" is moot, and I would not worry about having to defend any actions. It would never even get to discovery.

I forget the exact wording but legally yes once CPR is started you should continue until you are exhausted, are in danger, or medical personnel take over. But regardless of whether or not the family had POA, even if they didn't, common sense with an ?obviously? frail elderly adult in a nursing home nearing the natural end of their life a code is called and family says please stop the code I say stop! What is the worst case outcome? The family is going to sue you because you didn't save their loved one? The police are going to investigate a suspicious death? We can argue legal precedent all day which unfortunately seems to carry greater weight than common sense!

Famous last words LOL Laws and policy's and emotions don't always follow common sense. As long as the nurse is following the rules and policy's their but is covered. The minute you don't because you don't think someone will do something is usually when something ends up happening.