CODE STATUS

Efren Barragan, Joshua Torres and

Stephanie Duran
 PICO
 Problem: Patients code status is not clearly identified
and/or not easily accessible on Cerner for nurses and
other healthcare providers.
 Intervention:
To have the patients code status be identified
on Cerner where the patients other information such as
name, date of birth, gender and allergies are available.
 Comparison: Currently, a patients code status is only
located in the patients paper chart.
 Outcome: Patients code status to be correctly identified
and readily available during the admission process, in
case the patient’s condition deteriorates, the proper steps
of care can be taken.
INCONSISTENT CODE STATUS

 In a recent study done by Northwestern University,

researchers found that about two thirds of the
patient’s had inconsistent code status
documentation.
 Inconsistent documentation represents a serious
threat to patient safety and possible legal problems
for the hospital if the patient’s wishes are not
followed.
OBJECTIVE

 Ensure that there is a standardized location in the

patient’s electronic medical record/Cerner that
contains documentation of the patient’s
resuscitation preferences.
 This will allow the information to be readily and
easily found by physicians, nurses and other
healthcare providers.
CURRENT POLICY AND PROCEDURE
 Policy: P-8 Resuscitative Status and Treatment
Categories
RESUSCITATIVE STATUS FORM

• This is a pink sheet

that is suppose to be
placed in front of the
patients chart upon
admission.

• As of now this is the

only place where a
patients code status is
officially located- in the
patient’s paper chart at
the front desk of the
units.
RESUSCITATIVE STATUS FORM CONT.
CERNER
 Currently, there is a place where it specifies “Code Status” on the
patients SBAR page, but it is not being utilized and just simply
states, “Not Specified.”
CERNER CONT.

o Patients code status should be easily located where basic

patient information is found.
o The patients code status should be identified upon
admission.
o Clear and consistent code status documentation is a
prerequisite to providing care that respects hospitalized
patients preferences.
CERNER CONT.

o An area where the code status should also be

implemented is in the physician’s progress notes,
under assessment/plan of the patient.
o This will make sure that everyone involved in the
patients care is on the same page in regards to the
patients code status.
 POSSIBLE REASONS FOR CODE STATUS
INCONSISTENCY
1. Incomplete Documentation
2. Conflicting Documentation
- The patient may have a different code status
documented in 2 or more places
- The patient may come in with an out of
hospital DNR for but the UMC Pink
Resuscitative Form was never filled out and
signed.
NUMBER OF CODE BLUES OVER A THREE MONTH
PERIOD
COST ANALYSIS
 Cost of the medications located in the crash cart that are used
during a code blue/rapid response.
COST ANALYSIS CONT.
 Cost of the supplies located in the crash cart used during code
blues and/or rapid responses.
COST ANALYSIS CONT.

 The total price for one crash cart is approximately

$1,222.11
 If a patient was a DNR or Comfort Measures only,
and was resuscitative due to lack of inconsistent
code status documentation, the hospital is at risk
for being sued by the patient and/or family
members, which can vary up to 1 million dollars for
damages.
TYPES OF MALPRACTICE DAMAGES:
1. Cost of past and future medical treatment costs
(economic damages)
2. Reimbursement for lost income/earning potential
(economic damages)
3. Pain and suffering (non-economic damages)
4. Punitive damages (usually reserved for cases
involving egregious or outrageous conduct)
POINTS OF CONTACT

 Baltazar Banning, Lead PI Coordinator-Quality

Management
 Alexa Timbrook, CVICU Nurse Manager

 Ray Diaz-Perez, Supply Distribution Supervisor

 Yvonne Lazcano- Inpatient Pharmacy Manager

 Debbie Chasco, Director of Nursing Informatics

REFERENCES

 Sharma, R. K., & Breu, A. C. (2015). Making

Progress with Code Status Documentation. Journal
of Hospital Medicine, 10(8), 553–554.
http://doi.org/10.1002/jhm.2349

 Weinerman AS, Dhalla IA, Kiss A, Etchells EE, Wu

RC, Wong BM, Inconsistent Code Status
Documentation. J. Hosp. Med 2015;8;491-496.
doi:10.1002/jhm.2348

 http://www.alllaw.com/articles/nolo/medical-
malpractice/laws-texas.html