[Rita28]

I have experienced a problem with a reportable case in Longterm care. CPR started on full code resident and stopped by nurse on duty 911 never called MD called 1 hour later for pronouncement.
Although patient was just diagnosed as terminal I still believe this is a reportable incident to DPH , administrator disagrees but I feel this is wrong. HELP !!!!!!!!!!!!!!!!

[cougarnurse]

I work in LTC myself, and my DON has reports that she has to send to Public Health in regards to anything 'out of the ordinary' that happens. Perhaps your Admin. is telling you that it is being handled by the proper people?

'Cat'

[Carol]

If you are that upset, you might want to call who ever does the inspections of the nursing homes. In PA it is the Dept of Health. You can file a complaint without giving your name. That way they can investigate and you will feel like you did something rather than nothing.

[PsychARNP]

I'll add my comment. I'm not in LTC, but if your resident was a full code patient: 1) do the assessment, begin CPR per protocols. (you don't say if you had anything like the Zoll defib machine available or not???) 3.) Have someone call 911 to
initiate first responders from the community equipped to intubate, push drugs, etc. No indication of time the patient was "down", until efforts to resuscitate were stopped. Was the "code" witnessed by abyone? At the minimum, 911 should have been summoned to eval and treat as appropriate.
Change in the outcome??? Only an MD can call that one.
Maybe there needs to be a refresher course in the facility with regards code situations. ??? Just some thoughts...From your post, I am assuming the resident expired.

PsychARNP

[bdeherr]

I also work in LTC. We have an internal resolution process that encourages "blame-free reporting" for situations like this. The idea being, in order for all to learn, if someone feels a situation was not handled correctly, they are encouraged to report the incident internally, an investigation will occur and the person will be informed of the outcome. I would encourage you to give this pathway a chance before reporting the incident to the regulatory overseers, which can be viewed as not part of open and honest communication.
As far as the incident itself goes, with the information you have given, it would not seem that the nurse could "call the code", I beleive that, despite our feelings, if someone insists on being a "full code" that is their perogative, unless it has been decided by the team that this would be futile.

[Ricu]

It sounds like the LTC admin wants to sweep the event under the carpet; the last thing desired is an investigation. Did the RN think the resident was down too long? If the resident was a full code, CPR once started, should not have been stopped until a physician called it. Perhaps the RN could've called the physician and taken orders over the phone to terminate the effort if it was believed futile. That the resident had a terminal diagnosis doesn't matter. I agree with the suggestion to use a blame-free occurrance report for the purpose of reconstructing the event, for finding institutional weak spots and lastly but more most importantly, for creating education programs. Once the event has been reconstructed and the details known, the regulating agency must be informed. Now, what about the resident's family? Were they told? Should they be told? Ethically, they should know that their loved one was not resuscitated despite orders to do so. I'm not sure they must be told that it was started and terminated but that's a matter for legal counsel. My guess is that all staff members did what they thought was the right thing to do but conflicts and confusion ensued. I'm sure there was reasonable thinking on both sides of the issue of resuscitating this resident at that particular moment. What's done is done. Hopefully no legal activity would occur but if it does, so be it. I wish the best for all involved. Rita, if you're still watching, how are things coming along?

R