What type of prevention does discussing code status with each patient admitted to the hospital represent for Adult-Gerontology Acute Care Nurse Practitioners (AGACNPs)?

Discussing Code Status with Hospital Patients Represents Quaternary Prevention

Discussing code status with each patient admitted to the hospital represents quaternary prevention, as it aims to protect patients from unnecessary or potentially harmful medical interventions by ensuring their preferences for resuscitation align with their values and goals of care.

Understanding Types of Prevention in Healthcare

• Primary prevention focuses on preventing disease or injury before it occurs (e.g., vaccinations, health education) 1
• Secondary prevention aims to reduce the impact of disease or injury that has already occurred through early detection and intervention (e.g., screening tests) 1
• Tertiary prevention focuses on managing established disease to minimize complications and improve quality of life (e.g., rehabilitation) 1
• Quaternary prevention protects patients from unnecessary medical interventions that may cause harm, including unwanted life-sustaining treatments at the end of life 1, 2

Code Status Discussions as Quaternary Prevention

• Code status discussions help prevent unwanted, unnecessary, and potentially futile interventions at the end of life, which aligns with the definition of quaternary prevention 1
• These discussions ensure that life-sustaining procedures are not administered in contradiction to patient wishes, preventing harm from unwanted interventions 1
• Research shows that code status discussions can reduce rates of unwanted life-prolonging care while respecting patient autonomy 1
• When properly conducted, these discussions protect patients from medical interventions that might only prolong the dying process rather than improve quality of life 1

Importance of Code Status Discussions in Hospital Settings

• Hospital admission represents a critical time when patients are often at their sickest and encountering new caregivers, making documentation of care preferences essential 3
• Studies show that without proper code status discussions, there can be significant discrepancies between patient preferences and documented code status in medical charts 4
• In one study, 23.7% of patients had a lack of agreement between their stated preferences regarding resuscitation measures and what was documented in their medical record 4
• A majority of physicians (72.4%) report defining do-not-resuscitate status for patients without prior discussion, potentially failing to honor patient preferences 4

Barriers to Effective Code Status Discussions

• Healthcare providers often face barriers including personal discomfort with confronting mortality, fear of damaging the doctor-patient relationship, limited time to establish trust, and difficulty managing complex family dynamics 5
• There is significant variability in code status documentation across different healthcare settings (ranging from 2.8% to 24.9% in one multi-center study), suggesting institutional culture plays a major role 3
• Psychiatric inpatients are less likely to have code status discussions documented compared to medical inpatients (65% vs 96%), highlighting disparities in this practice 6
• Family members often ask more questions than patients during these discussions, creating potential conflicts between family wishes and patient preferences 7

Best Practices for Code Status Discussions

• The American Thoracic Society recommends using a structured, patient-centered approach for these discussions, providing a systematic framework while allowing flexibility to address individual patient needs 8
• Ensure a private, uninterrupted environment when discussing code status, and plan in advance what will be discussed 8
• Assess what the patient already understands about their situation using open-ended questions to establish baseline comprehension 8
• Provide information in small, digestible chunks rather than overwhelming the patient, and adjust your pace to the patient's reactions 7
• Acknowledge and respond to emotional reactions, allowing time for emotions to be expressed 8
• Conclude with a summary of what was discussed and ensure the patient understands the implications of their code status decision 8