Violating a Code Status...

An elderly female patient was admitted to the hospital with anemia, R/O GI bleed, dehydrated, c/o pain to right jaw. Admit orders were NPO, type and cross pending H and H, MRI/CT of jaw, rule out infection, d5 1/2 at 75 cc, resume current meds, mostly for DM and mild hypotension, coumadin and synthroid, pain meds ordered and place on telemetry. VS stable upon admit, patient a, a and o x 5, pain is under control. So far so good. Within 3 days she is diagnosed with Parotitis right jaw, transfuse 2 units RBC, place picc line, dc home for daily atb infusion. OK, moved to step down unit....

Day of this incident she is seen by nurse, signed consent for radiology procedure, returned at 1000, some bleeding at site but tolerated well. Spouse at bedside, patient ambulatory and requesting assist with a shower.

Nurse returns at 1210 to discover patient alone, laying on her side in bed, cyanotic, apneic, non responsive, no pulse, calls a code, which per notes happens over 12 minutes before they are able to establish both an airway and a pulse. She is transferred to ICU on vent, BP meds and ativan due to mild seizure activity. Family is notified.

2 days later, despite being on prednisone, intubated, removed from Versed for exam, neuro consult is very grim. Patient has gag reflex, dolls eyes, mild seizures and slowed brain wave activity. Patient is also at this time receiving Glucerna thru oral intubation as midline cath has infiltrated so emesis with positive CRX for fluid aspirate.

Now, upon review of this patients chart, an advance directive is found in the back which the patient and her husband had executed less then 2 years ago, both had checked off "If in the even I am found uncounscious, my condition will not improve or I am faced with artificial life support, including ventilators and advanced cardiac life support, I hereby decline and wish to advance towards a natural death without these measures". It was also in her admitting docs office charts and on file with this hospital.

It was not, however anywhere in her Kardex, anywhere in her admit notes, transfer notes or during a 24 hour chart check. 6 days she was being treated for this infection and no one saw this, nor was it mentioned. Someone finally did though, she was extubated on a Friday evening, given comfort measures, transferred to a med floor and finally passed away early on a Sunday morning.

Now, I guess we all know whom I am am taking about so issue is out of the way, but never in my years of nursing, even while covering for another nurse talking a bathroom break, lunch break, whatever, not know the code status of a patient. I have grieved and felt saddened by the loss of patients, have seen the tears, disbelief and sorrow at a loved ones passing but I always knew the code status and would never subject a patient to something they had gone out of their way to make sure would never happen to them.

People spend thousands of duckets on advance directives, wills and testiments and I am scared 3 shades of psycho to think it could be so blatently (is that conceivable) overlooked in such a way.

Well, in conclusion, always, always know your patients code status and keep your fellow nurses informed. No one should have to go thru this, especially a patient. What do ya say ?