In a nutshell: A 9-1-1 dispatcher pleaded with a nurse to administer CPR to an elderly woman. The nurse refused, saying it was agains the policy of the nursing home for staff to perform CPR. The 87-year-old woman died later at a local hospital.
The article states the woman was ‘hardly breathing’. Now, it’s been 21 years since I got an EMT certificate (which I never renewed, after finding out EMTs only made minimum wage), but ISTR that if someone is breathing at all, they don’t need someone blowing in his mouth. Also, ISTR that if someone is breathing, then the heart is beating. Am I remembering correctly? And if so, am I correct that CPR was not indicated in this situation? If so, it sounds like someone wanted to write a Shocking Story Of Negligence™.
I don’t understand how a nursing facility can have a policy that staff cannot perform CPR. Isn’t that why they hire trained people? Don’t nurses have a legal obligation to perform CPR when needed, regardless of what a facility’s policy may be? (Of course if the woman had a DNR order, that would be different. The article doesn’t say.)
This went around this morning, and as usual the news gives absolutely no answers to the logical follow-up questions.
So: Why would a nurse choose to NOT do CPR on an 87-year old?
I did some research and came up with two possible answers:
The patient had a DNR signed. This seems strange to me. If the patient did have a DNR, this should have been the first thing mentioned. Instead, they talk about the facility’s policies. I don’t really get it.
There is a great deal of concern about performing CPR on the elderly. I’ve been taught that CPR is a violent and painful process, and broken ribs are common. Elderly people have notoriously brittle bones, so much so that it would destroy their chest. Even if successful (and it probably won’t be) the patient will die of their multiple rib fractures. I read one account of a nurse who did CPR on a 90-year old man against his better judgment. He shattered every rib and left a concave depression where the patient’s chest used to be.
Is this correct? Does anyone have any experience with this sort of thing?
It also irritates me that I could come up with a decent answer in three minutes on Google, but the media refuses to mention it. One more example of how they want to make people scared and angry.
After what happened to my wife’s grandmother a couple weeks ago, nothing really surprises me about those places any more. She was at lunch with some friends when she started slurring her speech and didn’t recognize anybody. Classic signs of a stroke right? So do they immediately whisk her off to the ER for a timely introduction of clot-busting drugs? No, they take her down to the clinic and waste valuable time waiting for the doctor on call to get back to them. By the time they got to the ER and diagnosed her it was too late for the clot busters. Idiots.
The article doesn’t say why the nurse called 9-1-1. Maybe she was trying to get an ambulance to get the woman to an ER? There’s not enough information in the article, but it sounds like the dispatcher was the one wasting time.
My ex was a CNA, and when she was getting her certification the guidelines basically were:
You do not think
You have no autonomy, all your actions are decided by a higher tier nurse
If you do act, it’s probably illegal
She, indeed, had to get CPR certification but both her textbook, and later the nursing home at which she worked, made it clear that she is not permitted to issue CPR or any lifesaving measures and instead must find an RN or call 911, even if she’s technically licensed or trained for it. She said that the same restrictions were issued for LPNs, but were lifted for RNs and above.
It is clear from the article that you linked to that the ambulance was on the way, and the dispatcher was trying to get the nurse to do something before it arrived. The longer article I read about this incident said that it was the policy of the nursing home to do nothing. If that particular nurse was not able to do it, someone should have been available to.
I hope the state shuts that place down
By the way, I doubt that DNR orders mean that CPR is not given, since the woman was not dead in any way when the care was refused.
It’s difficult to come to any conclusions before all the facts are known. It’s a big assumption that someone who is dying wants extraordinary measures to be taken to keep her alive.
If there are vital signs, breathing and a pulse, you do not perform CPR. CPR is for people without vital signs, dead people.
We were trained in the CPR class I took a few months ago that the compressions required would break ribs and separate the ribs from the sternum. But not to worry because you are working on a dead person who might possibly be revived by CPR.
There are automatic defibrillator CPR packages that you attach the feeds to the person and it decides and instructs you when or whether to hit the button.
However, there are only a few minutes between a live person who may be revived and a permanently dead person.
The nurse should have followed the instructions from the 911 dispatcher if only to add a little blood movement and oxygen to the patient until help arrived. You cannot get those few minutes back.
That’s pretty much exactly what they mean. They would also mean don’t call 911,so it’s unlikely she had a DNR.
These days CPR is almost always exclusively chest compressions and on a healthy adult that usually means a cracked rib or two. My CPR instructor says “you can recover from a broken rib, you don’t recover from dead” but in the case of the elderly it’s not a sure thing that they can recover from multiple rib fractures. Also, CPR on its own only has something like a 30 percent survival rate, which is admittedly better than nothing, but again an elderly patient changes the math. It’s a shame they didn’t have an automatic defibrillator because that may have legitimately helped, but without more facts it’s hard to know anything real.
<puts on my 9-1-1 supervisor’s hat>
If the patient is not breathing normally and the description of the breathing indicates agonal respirations then CPR is advised.
</takes off hat>
Many times callers will refuse to administer CPR. Makes little difference if the caller is a staff member at a nursing home or John Q. Public. I would estimate 35% refusal rate, though in fairness some of those cases may be due to things like an expressed DNR wish.
Even for nursing home staff I have had to provide very basic step-by-step instructions starting with, “move then patient out of his bed and place him on his back on the floor or other hard surface.” Callers often express worry about hurting the patient while moving them to the floor. :smack:
NitroPress’s Law of Shocking Viral News Stories I: There is ALWAYS more to the story and what is left out is likely to make the story far less shocking.
I’ve done CPR three times and was quite certain I broke ribs in at least two of those instances. One Male in his 50’s, and another male about 40yo.
I don’t think I broke the ribs of the 9 year old girl. We got her back with CPR fairly quickly after she was pulled from a house fire. I think the breathing assistance was what she needed most.
I can only imagine that with the elderly their ribs would be much more prone to breaking.
:dubious: That’s exactly what DNR orders mean, because if you’re not dead, you don’t need CPR. It’s right there in the name–cardio-pulmonary resuscitation.
FWIW she was living in an independent living facility for seniors. I’m not sure it is an unreasonable policy for the nurses not to provide emergency care, and leave that to 911.