Mar 19, 2013

Will area nursing home nurses perform CPR?

What are the policies of nurses performing CPR in area nursing homes? Tom on Bogart Road

We sent the request to Steve Mould, who's a spokesman for the following nursing homes and assisted living centers in Erie County: Briarfield of Milan, Concord Care, Mill Manor, Parkvue, Providence Care Center, Commons of Providence and Portland House.

He provided the following answers:

• Ohio requires that Skilled Nursing Facilities provide CPR in the absence of a Do-Not-Resuscitate order issued by a physician.

• Residential care facilities are not required to have a nurse who is capable of providing CPR on the premises 24 hours a day, but Medicaid waiver providers requires that emergency care needs be met, including the provision of CPR.

• Independent living residences are not licensed as medical settings.

• If a center is licensed under Medicare or Medicaid, they are not allowed to have such policies in their buildings. That distinction is important. In a skilled nursing center, personnel are required by Medicare regulations to administer cardiopulmonary resuscitation if the person has not completed some form of advance directive asking that CPR be withheld.

• There are also case law precedents requiring skilled nursing centers to “protect a resident by (providing) CPR to a resident who was found unresponsive” if the person has not completed some form of advance directive asking that CPR be withheld.

• All families are encouraged to have a discussion about decisions regarding CPR and completing an advanced directive.

Erie County Care Facility acting administrator Donna Patrick also provided the response for the publucly maintained nursing home: 

We have access to an automatic external defibrilator and 24/7 RN coverage with all nurses trained in CPR responder training. We respect and honor the individuals decision in the event of a life-threatening emergency and discuss with the resident and/or residents responsible party what actions they would wish to be taken in the event of a sudden life-threatening emergency.

The Mailbag is a daily feature on SanduskyRegister.com. Every weekday at noon, we will post one question-and-answer from a resident. To ask a question, send a letter to The Mailbag at 314 W. Market St., or e-mail mailbag@sanduskyregister.com. Please include your first name and a location in the e-mail, e.g. “John from Decatur Street."

Comments

MrSandusky

I think it is important to note that the story a week or so back about the nurse refusing to do CPR on a patient involved a patient with a DNR. Many news agencies did not include that in their stories. Remember, fear sells stories!

BW1's picture
BW1

You need to go back and read. Three different news sources, explicitly stated that the patient did NOT have a DNR. That's why there is an issue.

deertracker

I think it is just cruel to keep these old, sick, and helpless people alive when the inevitable is obvious. Face it, there is no such thing as eternal life. Death is a part of life, the end of it.

Cowboy

Ok, I don't want deertracker as my nurse!

arnmcrmn

Talk about idiotic posts. And you know there isn't eternal life how????????

tiptapmom

As someone who has worked in a nursing home, it is sad to see some of the people who have a life of being confined to a wheelchair or bed. They have no one visiting them ever, but as soon as they take a turn for the worse, the room is so packed with "family and friends" it's hard to get something as simple as a set of vitals done and asking them to leave makes them upset. Let that person be, they have lived a long life.

Darkhorse

If the person were choking from stuck food in the throat in a cafteria setting, I don't think the DNA would apply. In that case, someone should come to the person's aid.

grandmasgirl

Someone I loved had a DNR. At the end of their life, all I could do is sit and hold their hand. Not everyone goes quietly into the night. Some linger on for years. It is cruel to keep them alive when all they want is to rest and see the face of God.

thirtysomething

Obviously, if a DNR is in place no life saving measures will be performed. But if not, that individual has made the decision that should require some measures to be taken. It's not for someone else to decide. "OH, poor Sally looks sad sitting in a wheelchair, let's just let her go..." I'm assuming that when a resident is admitted into a nursing facility the social worker explains the DNR and the family and patient makes the decision. I'd have to say that if no DNR was in place, and someone chose not to perform CPR (which may or may not work) that person and facility would be in danger of a lawsuit. There are plenty of nursing home residents who are lively and enjoy life. Just because someone is in a facility doesn't mean they are close to death. If it were me... the resident didn't have the DNR... I'd have drug that resident outside the facility and performed the needed CPR. Good Samaritan laws are in place to protect CPR performers and you need not be a nurse to have passed a CPR course for goodness sake.

deertracker

Good for you, if you happen to break a bone and the patient dies later from the injury or complication from, you will be sued! NO GOOD DEED........

thirtysomething

No, you would not be sued. Good Samaritan laws are there to provide protection from injuries when trying to save a life. You will invariably break ribs when correctly performing chest compressions. You are protected. In an accident you may need to move the injured to keep them from further danger. You may cause more injuries in the process, you are protected. When someone requires CPR they are dead. No pulse, no breathing. You cannot make someone deader??? lol I've been certified in CPR for the last 17 years. This is all reviewed during the training.
What I don't understand in this whole case (the care facility calling 911 becaues of a patient who collapsed) is why the heck did they even call 911? If you aren't going to help the person, why call?

SamAdams

Not everyone in a wheelchair is miserable. My grandmother spent her last days singing hymns with anyone who'd join her and reminiscing about her youth. She started her last days in a wheelchair and ended them in a hospital bed, but although her common sense had deserted her and she couldn't remember what she had for breakfast (or even if she'd had breakfast), she was happy.

That being said, she DID ask early on that no heroic measures be taken. Feed her? Yes. Care for her? Yes. But when she finally died at 98, it was of a simple bladder infection that got out of control because she didn't want treatment. Because no one interfered with her wishes, and nothing but pain medication was administered as needed, she died peacefully.

But that was her choice! To deny someone care in the absence of them having made a choice is criminal (literally), and cruel (certainly). Me? I'm still relatively young and in my right mind, but I've never-the-less prepared a living will just in case. There are too many questions, and too many "iffy" circumstances otherwise.

My heart goes out to caregivers who must often find it difficult to treat hopeless cases, and even MORE difficult to withhold treatment when the appropriate circumstances arise. But worst of all, I think, is the quality of life of those who've NOT planned ahead, and are effectively abused over and over and OVER again as heroic measures are taken that they can't refuse and that family members demand...

If we've learned nothing from news stories like the one referenced here, and questions like the one asked and answered here, it's our own fault. Living wills are cheap (in fact, you can find templates for them for free). Set out your own desires NOW while you're perfectly aware of what it is you want. Rescue your loved ones from such awful decisions, and make it clear to medical personnel what you do and do not want. However much easier your decisions may make it for YOU, just imagine how much easier it'll all be for THEM!

BW1's picture
BW1

What everyone seems to miss is that this isn't about DNR's. The facility in question had a policy prohibiting their employees from performing CPR on ANYONE, DNR, not DNR, or even on a 20 year old visitor who might collapse on the premises, out of fear of liability should they do so incompetently.

It's sort of like the policy of many retail chains telling their employees not to confront shoplifters because years ago, some Home Depot employees chased one, and he tripped and fell while fleeing, and sued the store.