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DATE: July 5, 2022
TOPIC: SBAR - Epic Code Status Revision
Situation
Although our Epic Code status selections support best practice, the current restriction on Partial Code needs revision to ensure the ability to fully capture patient wishes.
Background
Our code status choices were recommended by the System Palliative Care Collaborative, System CMO Committee, and a local Bioethics Committee. The recommendations were accepted by clinical leadership, which determined and agreed that allowing chest compressions for cardiac arrest without allowing intubation to treat respiratory failure could be an inappropriate order, could be considered futile, and could cause unnecessary harm.
Our Epic Partial Resuscitation code status order accommodates intubation without chest compressions, however, there is currently no choice for providing chest compressions without intubation in situations where this was the clear informed choice of the patient.
Assessment
Although there is clinical agreement that providing chest compressions in the setting of cardiac arrest without treating respiratory failure is futile, there may be rare situations where this determination is uncertain, or the patient/proxy understands but still wishes to have chest compressions without intubation.
Recommendation
The Epic code status will be revised for the “Partial Resuscitation” choices to include the ability to select “Provide chest compressions” with “NO Intubation.”
However, a message will be displayed with this choice that: “Relevant System Medical Leadership has advised that, in the setting of cardiopulmonary arrest, providing chest compressions without allowing intubation when indicated is most often futile. Please validate this choice with the patient or proxy.” An image is provided below (right-click to view).
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