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Discussion

Verbal Change in Code Status

Hello! May I ask you a question on how I should deal with a verbal change in code status, please?

Scenario is:

A resident's POLST says Full-Code.

Resident's condition suddenly deteriorated very fast and the resident says he/she does not want to go to hospital - resident is able to communicate, but confused at times due to early staged dementia.

The resident's primary doctor cannot be reached & the LTC facility's medical director is also cannot be reached, when the resident is about to pass away. The Responsible Party is also not answering the phone call.

In this case, what should I do? My facility's policy says that nurses need to respect the residents' verbal wish, so it looks like I need to treat the resident as a DNR status resident. However, at the same time, I would be scared to do so without any doctor's order.

I greatly appreciate your advice on this matter. Thank you!

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    I would honor the resident's wishes. Document everything

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    I would honor the signed POLST. If you have a signed POLST specifying full code, not following that means you're not following physicians orders. The family could come back and accuse you of failing to treat, especially if the resident has dementia and is confused at times. As much as you want to honor your resident's wishes, you also have to protect your license

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    In most LTC settings you'd still have to call 911 and have them sent to the hospital, as far as initiating CPR I'd call the MD as soon as I heard the patient say they didn't want to be resuscitated, It's not like they're going to say so the second before they have an MI, I would think there would be a little time to get further instruction.

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