What is Your Code Status?

In this episode, we will be talking about Code status. This is not only for medical professionals; this should also be known to anyone listening. The topic of code status can be confusing to many. Too often, code status is not discussed fully until a crisis with one’s health status.

What is the code status?

All patients admitted to a hospital or outpatient center are assigned a code status. Code Status essentially means the type of emergent treatment a person would or would not want to receive if their heart or breathing were to stop. 

Your chosen code status describes the type of resuscitation procedures you would like the health care team to do if your heart stopped beating and/or you stopped breathing. Resuscitation procedures are provided very quickly during this medical emergency to keep you alive. This emergency procedure is commonly known as cardiopulmonary resuscitation or CPR. 

In the same way, there are different treatment options and goals, and the expected outcome after a cardiac or respiratory arrest differs depending on the person, the severity of the illness, the cause of the arrest, and other factors. It is essential to discuss code status before a crisis occurs and as a condition changes.

The Outcome of Resuscitation 

Cardiac arrest is when the heart stops beating. About 350,000 cases occur each year outside of a hospital, and the survival rate is less than 12 percent. CPR can double or triple the chances of survival.

Even though CPR can restart someone’s heart, it can cause harm or even prolong the dying process. The success of resuscitative efforts is not like how it is shown on tv; the stats are relatively low. In 2016, the survival rate for adults after a cardiac arrest were:

• Out-of-Hospital Arrest: 12%
• In-Hospital Arrest: Less than 25%
• Survival rates are lower for patients with advanced age, cancer, sepsis, renal failure, or liver failure. The survival rates for patients with a chronic or advanced illness average 5% and less than 1%, respectively.
• More than 40% of survivors are discharged with a significant decrease in their functional ability. 

Different Types of Code Statuses

Like there are different treatment modalities, there are different code statuses. There isn’t only 1 route, and you can choose different options. However, there is a limit to what we can and can’t do. 

1. Full Code: We do anything and everything to try and bring you back. This includes CPR, intubation, medications, lines, and procedures. 
2. DNR: This is a Do Not Resuscitate order. When your heart stops, we will not attempt to do anything. We will let you pass without any interventions. 
3. Partial Code: This one can be a little complicated because there are a few measures you can choose to have done or choose not to have done. 
   1. Meds Only: If your heart were to stop, we would not perform CPR or intubation. What we would do is use medication to bring you back. We can push epinephrine, give bicarbonate, start levophed or other pressors to try and keep your heart beating or start it back up. 
   2. No CPR: Some patients do not want CPR performed but are open to everything else. Defibrillation, intubation, and medication are all used. 

Advanced Directives 

Advance directives are legal documents that allow you to write out your decisions about end-of-life care ahead of time. They give you a way to tell your wishes to family, friends, and healthcare professionals and to avoid confusion later on.

Health Care Power Of Attorney

The purpose of this form is for an individual to be named your advocate if you cannot make your own decision, even temporarily, such as in an accident. This person should know how you feel about life-sustaining treatment and other vital issues. This person does not manage anything related to your finances. First and second alternates may also be identified if the primary cannot be immediately reached.

Talk about why Code status is essential and different situations.

Sources:

https://www.covenanthealthcare.com/Uploads/Public/Documents/Workfiles/Pastoral%20Care/Advanced_Care_Planning/What_is_Code_Status.pdf

https://www.munsonhealthcare.org/media/file/6581.pdf

https://www.bvhealthsystem.org/expert-health-articles/advanced-directives-and-code-status

https://www.heart.org/en/news/2018/07/12/cpr-is-key-to-survival-of-sudden-cardiac-arrest#:~:text=Cardiac%20arrest%20is%20when%20the,triple%20the%20chances%20of%20survival.

https://medlineplus.gov/advancedirectives.html

Here’s what you know to know about these codes. Watch the full episode here 👇👇

TIMESTAMPS:

00:00 – Intro
01:00 – Topic introduction
02:07 – Why do we talk about the code status?
04:37 – What’s your relationship with death? And how do you cope?
08:48 – What is Code Status?
09:25 – Polish parents and Code Status
12:40 – Religious Beliefs and Code Status
14:36 – Turning Acute illness into Chronic issues
17:14 – Outcome of Resuscitation facts
20:38 – Codes happen during a change of nurse shifts
22:34 – Freezing the body after surviving the code
25:11 – Different kinds of Code Status
33:35 – Post Code Status scenario
35:10 – Advance Directives
37:50 – Don’t Let Your Family Decide
41:05 – Educating the patient’s family
47:04 – Your takeaway
48:16 – Wrapping up the show
48:42 – End of show