Ask the Nursing Expert about ... CPR
Angel McGarrity-Davis, RN, CDONA, NHA
How is the decision made whether a resident should be resuscitated?
It's a tough call. And it's never made in a calm environment or clear moment. But the decision to initiate cardiopulmonary resuscitation on a patient who presents with cessation of respiration and/or pulse isn't the nurse's decision to make.
That decision should be made by the patient and clearly documented in an advanced directive. Or if no advanced directive is in place, then in a Do Not Resuscitate order.
If you are faced with a patient in cardiac arrest, no pulse, not breathing, YOU NEED TO VALIDATE HIS OR HER DOCUMENTATION. Do not rely on any icons on a clipboard or color-coding on a roster. That leaves you and your license vulnerable to human error.
The only true answer is found in the patient's medical record. It is vital to know your patients and their wishes if they are faced with an end-of-life episode.
The Centers for Medicare & Medicaid Services has its guidance to surveyors to clarify a facility's obligation to provide CPR, stating “prior to the arrival of EMS (emergency medical services) a facility MUST provide basic life support, including the initiation of CPR in accordance with the resident's Advanced Directives OR IN THE ABSENCE OF an Advanced Directive OR IN THE ABSENCE OF a Do Not Resuscitate order.”
It is the responsibility of the entire interdisciplinary team, along with family input, to be sure the resident's wishes are clearly and accurately documented. They should be reviewed along with the care plan on a regular basis.
If you do not see such documentation present, then begin CPR. If there is a question regarding the validity of a Do Not Resuscitate order, begin CPR.
Do not put your nursing license at risk. Check the medical record and when in doubt, begin CPR