Code status of a patient? This probably isn’t a typical new nurse tip you would think of giving a new nurse because it seems self-explanatory. However, I have found out that discussing code status with a patient is one of the most overlooked things we do as healthcare professionals. As nurses, we tend to “just” trust the doctor’s order in the chart that says “Full Code” or “DNR”. Surprisingly, many patients have absolutely no clue about what a “code status” is and what it means to be a full code or do not resuscitate (DNR).
In this article, I am going to share with you an experience I had that changed the way I handle discussing a code status with a patient and give you some tips on how to discuss code status.
Real Nursing Story
This experience happened to a colleague of mine while I was present with her on the floor working. For me, this experience has been one of the most bizarre events in my nursing career and has left an impression on me.
And the story goes like this:
My friend who was taking care of a patient came up to me and shared with me her experience of what her patient just said to her regarding wanting to be changed to a DNR from a full code. She found it very odd because the patient was in decent health and was going to be discharged in a couple of days. The patient had come in for chest pain and had a stent placed and was almost ready to go home. So, she couldn’t understand why the patient was so adamant about being a DNR.
As we were pulling medications for our morning med pass, she said that she had got the patient up to the chair to sit and eat breakfast and was outside the room charting, when the patient abruptly out of the blue says “I’m going to die in this chair”.
In response, she said, “No, you’re not. Not if I can help it, you’re a full code and I’ll do everything I can to save you.”
The patient then said, “What do you mean a full code? What is that? I don’t want you to do anything…..let me die.”
She explained to the patient what a full code was and the patient immediately wanted to be changed to a do not resuscitate. He demanded she call the doctor and get an order for this.
The nurse followed out the patient’s wishes in calling the doctor. When she called the doctor, he was confused on why the patient was so determined to be changed to a DNR when the patient was responding to treatment and was to be going home soon.
The doctor requested the patient have the family come in and discuss the issue and if that was what the patient really wanted, he would change the order. The doctor and family came in and the patient was changed to a DNR.
The issue was not thought of anymore and we continued with our day. The next day we both were working, when I heard on the intercom “code blue” and it was a code on my unit. I ran down to my friend who was frantic because it was her patient from the other day sitting in the chair in cardiac arrest. The patient was dying, as predicted in the chair at almost exactly the same time yesterday he had told my friend he would die. The patient did die and everyone was shocked, including my friend, me, and the patient’s family.
This story always makes me think of the what-ifs and question if people really have the ability to “sense” if they are about to die (that’s an article for another day). The major “what-if” I think about with this situation is: What if my friend and her patient never had the conversation about code status that day? The answer: He would have been coded, which was apparently something he did not want. May be he would have lived and would still be alive today, or may be he would have been debilitated to the point of being in a “vegetable” type state with no quality of life feeling like a burden to his family, either way being a full code was something he didn’t want.
What I took away from my friend’s experience was that a doctor’s order for code status is just that an order, and as the nurse you should always double check it with the patient because many times a physician “assumes” the code status of a patient. In addition, even if the physician asks the patient their code status the patient may not know what it is and agree to something they wouldn’t want because they were too embarrassed to ask questions.
Tips on How to Discuss Code Status
- Do it at an appropriate time! Generally, when you first get the patient during your admission paperwork and assessment this is the best time to ask. If you ask the patient during other times, be sure you explain why you are asking because they may think something is majorly wrong.
- Sit down and educate them! As I said before, many people do not know what it means to be a full code or DNR. Explain it to them and provide them with educational material. Many hospitals have advance directive and living will paperwork that you can give the patient to fill out and all they have to do is get it notarized and it will be a legal document that says what the patient’s wishes are.
- Involve the family (as permitted by the patient)! It gives some patients much comfort in having their family present and involved in sensitive issues as these. In addition, it helps the family understand what the patient wants if they can no longer make decisions for themselves.