performing CPR on a DNR patient.

  1. I had a "new admit" found unresponsive, no pulse, no RR at the beginning of my shift. What makes this such a crappy situation is the fact that NOWHERE in his chart did it say that he was a DNR. Naturally a code was called. This was a very old man, but because he had no DNR orders we had to code him. We began CPR as some of the assistants started making all of the STAT calls. When someone contacted the MD he said that the patient was a DNR and ordered to stop the CPR. Eventually, the DNR papers were found in the admissions office of all places.

    I was completely ticked off when it turned out that this patient was a DNR. It made us all look stupid to try to resucitate him. It was twice as bad knowing that this was not what he wanted.
    Still, I don't think that we were wrong in doing the CPR as we had no way of knowing what his wishes are thanks to the office.

    To top off the wonderful evening it was suggested that no one chart that CPR was initiated since it shouldn't have been. It did get charted though.

    This was a week ago, but it bothers me very much. I'm just wondering if any of you have ever been in a situation similar to this or if you guys have any thoughts about it.
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  2. 6 Comments

  3. by   wv_nurse 2003
    I witnessed a similar, but quite different situation. A frequent patient to our hospital with multiple medical problems always was admitted as a DNR. She was an intelligent woman with the foresight to appoint a MPOA, and a living will. She arrested upon admission to the ER one morning. Her daughter, who was MPOA INSISTED everything be done to revive her. Everyone tried to talk to her, but she was insistent. The Doc felt pressured to do something, so he initiated the code.

    The patient was resuscitated, and after spending a day on the vent, was extubated--and was she P*SSED!!!! She "fired" the daughter as MPOA, and had a HUGE family meeting making clear (again) her wishes to be left to die in peace.

    She did pass away a few months later--in peace, just as she wished.
  4. by   Tweety
    I can't say I've ever seen that situation before. I have had families and MDs make a person a DNR in the middle of a code several times. Why not make up your mind prior to death? Duh....

    It's also frustrating to have to code someone who very clearly doesn't "need" to be coded, i.e. the extremely old, the terminally ill, etc.
  5. by   ShandyLynnRN
    I have seen it happen as well. I was floating to an ER, and had a resident come in by ambulance from a local NH for GI bleed. He coded as he came in the door and CPR/ACLS was initiated.... Never got a report from the NH that he was DNR, and only found out about it after he was pronounced when we looked through the records sent from the NH.

    Everyone from doc to nurse to EMT felt very badly about this situation, but it does happen.

    I think if it were me, and they weren't sure, I'd almost feel better knowing that they tried to do something, "just in case".

    Now when the families "override" a DNR that a competent person has requested... that just heats my chili!!!
  6. by   Nurse Ratched
    Originally posted by TNcanNURSE
    I don't think that we were wrong in doing the CPR as we had no way of knowing what his wishes are thanks to the office.
    You did exactly as you had to by law - in the absence of a written order of DNR status, you MUST attempt to resuscitate.

    This is a great example of why a thorough report from admissions staff to nursing staff is vital BEFORE the patient arrives. Hopefully your management will use this to improve their communications. People will up and croak on you at the most inconvenient times.
  7. by   kids
    Originally posted by ShandyLynnRN
    ...had a resident come in by ambulance from a local NH for GI bleed. He coded as he came in the door and CPR/ACLS was initiated....Never got a report from the NH that he was DNR, and only found out about it after he was pronounced when we looked through the records sent from the NH...
    Sadly, here in WA EMS would have had to code him anyway. Some funky rule about the facility DNRs and Physicians Orders not applying, a person has to have a seperate "Directive to EMS".
  8. by   ShandyLynnRN
    that is definitely interesting. I wonder how many ppl with DNR's in your state actually know this.

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