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2014-07-21 at 16:38

Life options

By Leith Dunick,
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Patients admitted to Thunder Bay Regional Health Sciences Centre will now have five sets of instructions for doctors and nurses should they suffer a cardiac or respiratory arrest or unexpected deterioration.

Following the lead of other hospitals in Ontario and across the country, Thunder Bay Regional has implemented a new policy they say gives patients greater control over their level of resuscitation should an incident occur.

Health-care providers have now been instructed to go over the options within 24 hours of admission.

Patients in the end of life care can choose a Level 1 armband, which instructs doctors to provide comfort measures only. A Level 2 patient does not want CPR or ventilator support, but full medical therapy. Level 3 patients don’t want CPR, but will accept non-invasive ventilation including life support, while Level 4 patients want rescue breathing up to intubation, if necessary.

Level 4 and 5 patients receive a lavender armband, while Level 2 and 3 patients receive a blue armband.

Patients who wish to be fully resuscitated will receive no armband and be given full CPR and advanced life sustaining therapy as required.

Critical care physician Will Anderson said the policy took about four years to create, and mixes in existing regulations while helping patients, their families and their loved ones understand the options that are available to them.

The new code level system replaces the Do Not Attempt Resuscitation order that Anderson said was too vague and open for interpretation.

“The five different code status levels actually reflect what is current practice in this hospital,” said Anderson, adding they consulted staff and patient family advisors before making the switch.

“In the past we had a rather artificial dichotomy where a patient would either be a full code or a code, or a DNAR, which meant do not attempt resuscitation. The problem with that is we never knew exactly what it meant.”

DNAR meant different things to different patients at different times. Staff would often get called about patients listed as DNAR who really did want resuscitation and life support, if it meant they would have a good outcome.

“These conversations weren’t really happening beforehand and we needed to really sort out what their true wishes were. We found having a black and white full-code, no-code dichotomy really didn’t work. So we’ve really just taken what we actually do and just broken it into five different levels,” Anderson said.

Patient family advisor Jan Miller, who spent five months in hospital, said being able to tell one’s doctors – or have a family member express one’s wishes – is a great improvement.

“Having these conversations with your family or substantial decision maker gives them the confidence that the decisions they make are precisely as outlined.”

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ring of fire dude says:
Armbands ? Really ? Either you want to be resuscitated or not , this was the option given to my Wife when she was dying of cancer . Can't they just put something on the bed or chart or better yet have the Doctors and Nurses aware what the Patient wishes are . This idea sounds like it was made by someone's teenager at a rave party , this is end of life , dignity and respect are supreme .
7/21/2014 7:09:09 PM
progress now says:
An armband???

Sounds like something out of Stephen Kings Kingdom Hospital.

I'm horrified. What they don't say here is how graphic the explanations are respecting the different kinds of resuscitation. Elderly people or anyone in distress might well give up and die right there.

Having been through this a couple of time with my parents, I shouldn't be surprised.

This is what happens when bureaucracy prevails over the elderly and infirm.

7/21/2014 7:20:42 PM
caesarjbasquitti says:
Excuse me !

A few years ago, we were looking after an elderly man who was admitted to the hospital.

This man, was in great shape, yes he was old, and did not look very well in bed, or tied up (seems he was tied up, because he was wanting to walk or go to the washroom...) anyway, the last time he went to the hospital, we were confronted by an 'ethics staff member' who was quick to point out that she had not resuscitated her father, a father who died in a week, in the hospital with a very serious form of cancer.

I was shocked to hear this, since this elderly man, was in great shape, problem he did not have a family doctor who visited the hospital and knew this man.

Well in and out of Intensive care, for different reasons, problem with changing doctors every day, however, some doctor who thought he was God, FORCED a purple band, do not resuscitate order on this man.

Tragic to see this first hand, by a staff member who probably was more interested in eliminating the gridlock, than..
7/21/2014 9:54:10 PM
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