Slow code
Slow code refers to the practice in a hospital to purposely respond slowly to a patient in cardiac arrest. The related term show code refers to the practice of a medical response that is faked for the sake of the patient's family.
Background
During a patient cardiac arrest in a hospital or other medical facility, staff may be notified via a code blue alert,[1] to which a medical team will respond.[2] The team will perform cardiopulmonary resuscitation (CPR) in order to re-establish both cardiac and pulmonary function.[3]
Cardiopulmonary resuscitation may be withheld under some circumstances, such as one in which the medical staff deems that CPR will be of no clinical benefit to the patient.[4] This includes a patient in septic shock, one who has had an acute stroke or who has metastatic cancer, and one with severe pneumonia, which all have no probability of success.[5]
Practice
Slow code is used in response situations for which CPR is of no medical benefit. The medical staff at the facility will purposely respond slowly or incompletely to a patient in cardiac arrest.[6] When a medical response is faked for the sake of the patient's family, it is referred to as a show code.[6]
Ethics
The practice is "controversial from an ethical point of view",[7] as it represents a violation of a patient's trust and right "to be involved in inpatient clinical decisions".[8]
New York became the first state in the United States to ban the practice in 1987.[6] The law also required medical staff to honour a patient's refusal of cardiopulmonary resuscitation.[6]
Notes
- ^ Marks 2006.
- ^ NBC News 2008.
- ^ Braddock 1998, When should CPR be administered?.
- ^ College of Physicians and Surgeons of Ontario 2006.
- ^ Braddock 1998, When is CPR not of benefit?.
- ^ a b c d New York Times 1987.
- ^ DePalma et al. 1999.
- ^ Braddock 1998, What if the family disagrees with the DNR order?.
References
- Braddock, Clarence H. (1998). "Do Not Resuscitate Orders". Ethics in Medicine. University of Washington School of Medicine. Retrieved 2013-04-06.
{{cite web}}: Invalid|ref=harv(help) - DePalma, Judith A.; Miller, Scott; Ozanich, Evelyn; Yancich, Lynne M. (1999). ""Slow" Code: Perspectives of a Physician and Critical Care Nurse". Critical Care Nursing Quarterly. 22 (3). Lippincott Williams and Wilkins: 89–99. ISSN 1550-5111.
{{cite journal}}: Invalid|ref=harv(help); Unknown parameter|month=ignored (help) - Marks, William J. (1 January 2006). ""Code Blue", "Code Black": What Does "Code" Mean?". WebMD. Retrieved 2013-04-06.
{{cite web}}: Invalid|ref=harv(help) - "Decision-making for the End of Life". Physician Advisory Service. College of Physicians and Surgeons of Ontario. 2006. Retrieved 2013-04-06.
{{cite web}}: Unknown parameter|month=ignored (help)CS1 maint: others (link) - "Hospitals' 'code blue' most deadly at night". Chicago: NBC News. Associated Press. 19 February 2008. Retrieved 2013-04-06.
- "Slow Codes, Show Codes and Death". New York Times. New York Times Company. 22 August 1987. Retrieved 2013-04-06.
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