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<p>I’m thinking that the last time I took BLS, they were just about to institute this. In hospital, of course, we always do full CPR between shocks, but of course we are using ambu bags and intubation is done when the proper personnel arrives.</p>
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<p>And I imagine that the survival rate for full cardiac arrest outside of a hospital in patients of 87 years is even less.</p>
<p>My biggest problem with this article is not that the employee was not required to perform CPR, but that she was apparently forbidden by policy from doing it. At least that’s the impression I got. Often in these situations, the reality differs quite a bit from the early reports.</p>
<p>For those of you who are justifying the refusal to do CPR by the staff because the person is ‘old’ - i.e. beyond whatever age you think a person s/b be provided potentially lifesaving basic assistance, CPR might not save the person anyway, that the person is better off dead, etc., realize that their procedures are to call 911 which is what this worker did. When they do that the responders almost certainly WILL administer CPR so the argument that this withholding of CPR administration by the worker is some kind of merciful reaction or justified in a DNR sense goes out the window. By not administering CPR all they’re doing is increasing the likelihood the person will die or become brain damaged depending on the response time of the paramedics. And yes, it’s probably more likely that an elderly person would die than a younger one if administered CPR but that doesn’t mean it s/b withheld just because the odds of dying are greater. That’s kind of the point of doing CPR in the first place - to increase the odds of survival. If it fails then it fails. This is like saying doing any medical procedure on someone who’s older (even 70 or 80) has more risk. It has more risk but that doesn’t mean not to do it.</p>
<p>When there’s a DNR that’s followed, not only is CPR not administered but 911 wouldn’t be called either. It doesn’t make sense to do one but not the other.</p>
<p>I relatively recently toured several assisted living facilities (some of which also had independent living facilities as well as skilled nursing facilities) and even signed all of the forms for one of them and not once was it raised that the staff wasn’t permitted to perform basic CPR. It may have been in the fine print but if it is I missed it and I actually read all of the paperwork. It frankly wouldn’t have occurred to me that a facility like this would have a policy against this basic kind of assistance and (bad on me) I didn’t ask. I honestly don’t know what their policies are but if I find myself in that mode of checking out facilities again I’ll certainly ask this basic question.</p>
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<p>I would only add that CPR is nevertheless still important. If you can keep the patient alive and his brain perfused long enough for EMTs to get to him, there is a chance that between the shocks and emergency medications that they can add to the mix, you can get a sustainable rhythm. Yes, chances are not great that this person makes it, but I would want to at least try to keep CPR going until the EMTs arrived even if the AED didn’t seem to be doing the trick.</p>
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<p>It wouldn’t have occurred to me, either. I find this policy quite surprising and am now wondering if this is in fact common.</p>
<p>GladGradDad, what if you discover that they all have a no-CPR policy? Would that mean your parent stays in their home, where they are alone and there’s no one to quickly call 911 in an emergency?</p>
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I don’t know Lasma. Certainly when they’re alone, either at home or in a facility, no one’s going to be able to perform CPR and one could argue that they have other benefits from being in the ILF/ALF/SNF (they could easily be in their room alone for extended times at an ILF) which could sway the decision even if they have their policy against CPR.</p>
<p>My ideal would be that they’d not have a policy against basic first aid such as CPR, performing a Heimlich maneuver if they start choking on their food in the dining hall, and certain other basic reactions. </p>
<p>I don’t know how pervasive the policy of not performing these basic items is in these kinds of facilities.</p>
<p>I am sure the management of every ILF/ALF/SNF is now reviewing their own policy. They are probably getting lots of questions from residents/family members. </p>
<p>The call is hard to listen to, but I do appreciate the complexity of the situation. I am glad at least that the family seems to be at peace with the chain of events.</p>
<p>Does any one know if their are medical alert bracelets with DNR on them? I am just curious how - outside of a medical environment or with a family member present - one would know if the patient had a DNR. My dad had one, which my mom had to produce whenever there was a change in care.</p>
<p>I cannot imagine ANYPLACE where CPR is not permitted. I don’t care if that is a nurse or what the facility is. Yes, one takes ones chances that CPR may not be given in any given place, but this place has a policy that it is not permitted. I am fully aware that CPR might not be indicated for some people, some people may even refuse it officially, but for a place to have a policy where you can’t get it, is insane. What if that had been a visitor , child anyone else that needed CPR? </p>
<p>I am not in my 80s but am approaching the time when assisted care communities are something I cam considering. It appalls me that it is a possibility that some places might have this sort of policy. Not something that would have occurred to me at all.</p>
<p>Mind you, what happened is not what bothers me. Not enough information in that it is entirely possible that the person who died should not have had CPR, did not want CPR. It was the fact that there was a policy in place preventing that from happening. That nurse should have placed the call and then hung up, giving comfort to the patient instead of going on a discourse with the 911 dispatcher, in this case , if it were indeed the case that CPR was not indicated. The good thing about all of this is that now more of us are aware that this policy can be in place at these assisted living residences.</p>
<p>I mentioned earlier, having just moved my mom out of a 3 year ALS experience, I would be surprised if CPR would be withheld. Although, I never even thought to ask in advance. My experience was mostly good. She was in a brand new ALS bldg with a lovely 2 bedroom apartment. The central dining facility was a beautiful restaurant quality environment. Now over time we did learn some unadvertised rules regarding levels of care. Mostly staff would consist of a couple LPNs and aides. unfortunately, on weekends, when LPN staffing seemed tough, often an additional aide might be around. We even found dietary aides being utilized as “observers” for some residents. As my mom began to exhibit some dementia issues, they began to worry she might walk out. And she did! One day she was found nearly a mile away, thinking she was walking home after work. It was hard to place blame. ILS/ALS patients are generally allowed to come and go. This was only one issue that prompted a move to skilled, but it was a necessary move. ILS/ALSs a temporary placement for sure. Most average less than 18 months. But as a self pay, they often cost a third of the skilled nursing facilities and provide the resident with some sense of independence, at least for as long as they can before they become a huge liability for the facility. At the end of the day, it is a business, and the loyalties will be protected as such. In hindsight, I would do it again. The positives far outweighed the negatives of my mom living on her own.</p>
<p>emerald, it appears from the quote in post 69 that Glenwood gardens has an independent living facility, an assisted living facility, and a skilled nursing facility. Based on the quote below, I’m inferring that the incident took place in the independent living facility.</p>
<p>Someone living in an independent living facility must be fairly healthy, & it seems to me that it is even more egregious that no one was permitted to try and save her life.</p>
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I don’t know the answer to your question but in my experience hospitals and SNF facilities want the actual signed paperwork on file in their office. They understandably need to be concerned about legal consequences of NOT administering resuscitation without the appropriate legal documentation directing them not to. Given that, I’m not sure the wearing of a medallion saying ‘Do not Resuscitate’ would be adequate for a paramedic or medical facility to withhold resuscitation.</p>
<p>At the end of the day, providing CPR, Heimlich, etc., having a DNR which might or might not be known to the medical responders, is on a best effort basis. The procedure might work and it might not, the DNR might be able to stop someone from doing a procedure or it might not (if it’s not known about), but it’s the lack of at least putting in the effort that’s the concern here.</p>
<p>It’s hard to believe this is an RN but the woman does identify herself as a nurse. It makes no sense for this facility to employ actual nurses at actual nurse pay rates, to do little more than babysit. I hope this was some kind of an aide who couldn’t see beyond the regulations which had been drilled into her by her employer.</p>
<p>^^^^Yeah, I just re-listened to the call and she does identify herself as a nurse. In my state, it is illegal to call yourself a nurse if you are not a licensed vocational nurse or a registered nurse. But I know that some people continue to call themselves nurses when they are not. But I’m going to take her at face value and say she is a nurse. It’s hard to imagine a nurse not doing CPR. It’s just part of my nursing DNA to start CPR on someone who is not breathing and doesn’t have a pulse. I just don’t think I could possibly stand by and do nothing. I don’t even know how this could be kosher legally as I would bet their nurse practice act has some kind of verbage about responsibilities to patients while at work. When I am at the GI lab, we call 911 if we have a patient to appears to need emergency care as we are not an emergency room. However, we have a crash cart and we would definitely start a code if a patient “collapsed” and would run it until the paramedics arrived.</p>
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<p>I think the fact that it was an independent living facility is mainly relevant with regard to the legality of their policy, not the ethics of the situation. I’m thinking that they could never get away with having a policy forbidding CPR in a non-DNR patient if they were an actual medical facility.</p>
<p>If they have a no-CPR policy, I would be interested to read the transcript of their next licensing hearing. </p>
<p>I’ve done CPR on many, many people and only my neighbor walked out of the hospital and he was under 50 and experienced cardiac arrest and his wife started CPR immediately while his teenage daughter called 911, then me.</p>
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It would be in New York state. [Frequently</a> Asked Questions re: DNR’s - New York State Department of Health](<a href=“http://www.health.ny.gov/professionals/ems/policy/99-10.htm]Frequently”>http://www.health.ny.gov/professionals/ems/policy/99-10.htm)
I mentioned earlier that my senior center recently presented a program about out-of-hospital DNRs. A living will covers patient wishes in a hospital setting. But for someone stricken at home, or in a public setting, CPR and other resuscitative measures will be taken by EMTs when 911 is called - unless the out-of-hospital paperwork is presented at the scene, or a DNR medallion is worn. Most of the seniors at our program were still independent and in relatively good health. Even so, the large majority of those present felt that they would not want to be resuscitated if their hearts stopped suddenly. Their feeling (and this was certainly a self-selecting audience) was that, if they could be spared a lengthy, costly, difficult death, they’d consider it a blessing to go quickly. A surprising number of them thought that they wouldn’t be resuscitated, just because their kids knew they wouldn’t want that. They hadn’t thought about what happens when 911 is called.</p>
<p>DNR medallions can be obtained from several vendors. Having an out-of-hospital DNR (signed by a physician) or Medical Orders for Life Sustaining Treatment form (ditto) is a requirement, and organizations such as Medical Alert (<a href=“http://www.medicalert.org/services/seniors/dnr-services[/url]”>http://www.medicalert.org/services/seniors/dnr-services</a>) keep electronic copies on file. However, as per the New York State Public Health website, EMTs are to presume that a DNR order exists when a DNR medallion is worn.</p>
<p>frazzled1:</p>
<p>I just checked and my state accepts DNR medallions as well but only from two recognized providers so they’re very careful in this area.</p>
<p>Furthermore, the state states this -
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<p>Would an independent living facility necessarily need to be licensed? Isn’t it in fact just an apartment complex market to seniors? Their assisted living facility and skilled nursing facility would probably have to meet a different standard, and as the director states, the no CPR policy does not apply in those facilities.</p>
<p>@ post 118 - Yes, our paramedics stated that they would begin CPR in the absence of the proper order or a medallion, which is what they ought to do. I meant to emphasize that, when the person is wearing a medallion, our paramedics would not seek additional evidence of a DNR order, since the regulation specifically states that wearing the medallion is to be considered the same thing as presenting the order.</p>