Facility is a SNF, Pt codes, family at bedside, after a few minutes of the code the son, Med POA, requested to stop the code. The person running the code a LPN refused to stop citing a rule that once the code starts it cannot stop until medics arrive. Unit manager, RN, starts screaming at the LPN to stop the code in between the son's pleas to stop. Medics arrive, take over the code and immediately stop.
If the POA requests an ongoing code to stop can it be stopped without the medics or a MD present?
Specializes in Emergency Dept. Trauma. Pediatrics.
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.
Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych.
Sorry, the RN was wrong. If the code has already begun on a full-code patient, it cannot be halted until EMS arrives to make that decision. No matter what the POA was saying at that point in time. Someone should have taken charge of calming, removing, distracting, etc. the family at the time if possible.
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.
To be fair a RN's Scope of Practice in Arizona does not address this issue and there seems to be debate of the "legalities."
Some of you seem to be quick on the judging of the RN. You cannot fault someone for attempting to advocate for her pt and/or family. I think everyone involved in that code had a VERY hard time dealing with it...
The problem is that no one seems to know if this is a civil or criminal matter. I am not asking if the Nurse or facility can be sued...rather is it legal or does anyone know of some kind of legal precidence in any of the States they worked in orcurrently reside?
Lawsuits....I am not even worried about lawsuits anymore. The list of things you cannot get sued for is much shorter than the latter.
The problem is that no one seems to know if this is a civil or criminal matter. I am not asking if the Nurse or facility can be sued...rather is it legal or does anyone know of some kind of legal precidence in any of the States they worked in orcurrently reside?
Unfortunately, these incidents do occur. Sorry for the RN and LPN involved. It is a very stressing situation. We had a similar situation, except in our case. Per daughter's request, the night LPN did not even start CPR. 90-something, frail resident was found unresponsive, daughter requested no CPR. When RN arrived to pronounce realized CPR was not initiated and had to call incident to state. Our facility was placed in IJ. HORRIBLE TO SAY THE LEAST. Both the LPN and RN were referred to the board. Still pending outcome. So if you want to be a resident advocate. Start with talking to responsible parties or POA on admission or during stay, PRIOR to any situation. ITS OUR LICENSE ON THE LINE! Even if we don't agree. I think that has to be one of the hardest things to accept working for LTC.
in FL it varies from county to county, the next county up has jumped through enough hoops that their paramedics are allowed to call a code in the field. Ironic part is, their medical director is one of our main ER doctors, our county doesn't have that option so once a code is started, it doesn't stop till they get to us and he calls it. And wouldn't you know, good 'ol Murphy is alway looking out for us *HA* this usually happens the nights he works.
In NC in a hospital setting when the ER was slammed and the ER doc couldn't get to our code, an hour in.... I had several arguments with the attending MD to get his hind end and call it. Finally, the administrator on call spoke with the attending and sure enough... 90 cruel minutes into a futile code it was called.
We do many cruel and inhumane things to our patients because of POA's. ONce dead and not a DNR... as an RN... I can't call it. Didn't ever say it was ethical... but then we'd be having some pretty short codes some days if ethics was practiced instead of medicine;)
Both the LPN and RN were referred to the board. Still pending outcome. So if you want to be a resident advocate. Start with talking to responsible parties or POA on admission or during stay, PRIOR to any situation. ITS OUR LICENSE ON THE LINE! Even if we don't agree. I think that has to be one of the hardest things to accept working for LTC.
~Mi Vida Loca~RN, ASN, RN
5,259 Posts
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.