Disaster in the making

Dilbert DNRYesterday. Arrived to the floor, received patient assignment. Logged in to the EMR and saw a new order for patient #2: Code Status – DNR. On rounds mentioned the change to the patient and family, and was met with confused stares, head tilts, and the non-verbal equivalent of “huh?”

A brief exchange took place in which I informed them that DNR means we would not perform CPR if the patient’s heart stopped beating. “Oh, no. We want all the regular stuff to be done. Just not the really, you know, extraordinary measures.” What’s extraordinary to one person might be entirely commonplace to another. Hence, confusion ensues.

As any competent nurse would do, I contacted the doctor immediately and reported the confusion about code status. Thankfully, it’s the doctor’s role – not mine – to sort out all the details. In the end, the patient was restored to full code status, and again, thankfully, it happened before I had to make a tough choice about whether or not to rescue. I admit that I had a mini panic attack – if he codes, do I resuscitate? Do I follow the legal order and risk repercussion? Or do I follow what I’ve been told the patient and family wishes? (pleasechangethecodestatus, pleasechangethecodestatus, pleasechangethecodestatus…)

Doctors, nurses, anyone out there who is listening: code status is important. And not everyone knows what they want, or what their loved ones want. We have a duty to clearly explain options and consequences. If you’re looking for resources on where to start, try Deathwise and Life Matters. But please, have the conversation. And patients, confirm with your doctor what your wishes are – make sure everyone is on the same page.

Once you have legal documents, make sure they’re handy with the American Bar Association’s super intuitive app – My Health Care Wishes.  (Love it!) $3.99 on the itunes app store, and totally worth it.


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