In healthcare, a patient’s code status signifies the medical interventions they wish to receive or (often more consequentially) to decline during critical illness, cardiac or respiratory arrest. These choices carry tremendous personal significance, shaping the extent to which medical teams intervene in life-threatening situations. In this post, we explore the basic definitions and implications of Full Code, Do Not Resuscitate (DNR), and Do Not Intubate (DNI) code statuses and examine the significance of the term “Full Code” to us as a medical education company.
Different types of code status
1. Full Code
As you know, Full Code is the name of our company, but what does full code mean in medicine? Designating a patient as Full Code signifies that all available resuscitative measures will be used during cardiac or respiratory arrest. This includes CPR, defibrillation, intubation, and medication administration and other types of critical life support, such as dialysis, blood transfusion, IV nutrition and hydration. In the absence of direction from the patient or their representative or an advanced directive or physician orders for life-sustaining treatment (POLST), Full Code is the default code status.
2. Do Not Resuscitate (DNR)
A Do Not Resuscitate (DNR) order directs healthcare professionals to abstain from aggressive resuscitative measures during cardiac or respiratory arrest. Patients electing a DNR code status choose to forgo extraordinary measures, while maintaining other medical interventions. Specifically DNR patients do not receive CPR if their heart stops. However, patients who are DNR only may consent to undergoing intubation and mechanical ventilation and may also receive other types of medical support.
3. Do Not Intubate (DNI)
Do Not Intubate (DNI) status specifically means a patient has elected not to have a breathing tube inserted and be placed on a ventilator in the event of respiratory failure or arrest. A patient electing DNI status typically also elects DNR status. Patients who are DNI / DNR may still receive many other types of medical intervention or supportive care.
4. Comfort Measures Only (CMO)
Comfort measures focus on providing relief from suffering and enhancing the patient’s quality of life during critical illness or at the end of life. A patient who elects to be CMO accepts treatment for pain, anxiety or other physical symptoms (e.g. shortness of breath) but otherwise declines specific medical therapies, such as antibiotics, surgery, chemotherapy or blood pressure support. It is important to note that holistic care for patients well-being and relief of symptoms is important no matter a given patient’s code status.
5. Physician Orders for Life-Sustaining Treatment (POLST)
A POLST — typically a written form signed by a physician – plays a key role in management of critical illness and end-of-life care. POLST documents outline specific treatment preferences in emergencies, providing actionable orders for healthcare providers. Interventions may include electing (or declining) testing and treatments such as diagnostic imaging and lab testing, IV fluids, antibiotics, blood products, noninvasive ventilation, dialysis or artificial nutrition. In this way, a POLST can provide more granular information on desired interventions that may fall outside the scope of the code status. Of note, regulations around code status and end-of-life care vary based on jurisdiction and practice environment. Legal requirements differ between countries, states, and regions, and healthcare facilities often have unique protocols. Awareness of the local practice landscape is crucial for healthcare professionals.
Our Connection to “Full Code”
For us, “Full Code” is not just a name; it’s a philosophy. It signifies our relentless pursuit of excellence in medical education. In the same way that Full Code status represents an unyielding dedication to providing the full spectrum of medical interventions to patients, our mission is to ensure that healthcare professionals, from seasoned practitioners to those just starting their careers, are equipped with the knowledge and skills needed to address the broadest possible range of diagnoses and clinical situations.
Beyond clinical medicine, the “Full Code” name also signifies our profound respect for patient autonomy in medical decision-making. We consider compassionate patient communication to be cornerstone of the practice of healthcare. We’re dedicated to ensuring that healthcare professionals worldwide have access to the resources and expertise required to deliver evidence-based medical care that aligns with patients’ preferences and values and gives clinicians-in-training the skills to evaluate and treat patients compassionately.
Through Full Code, we aim to bridge the gap between medical knowledge and compassionate practice, fostering a healthcare community that not only possesses technical expertise but also embodies the principles of empathy, respect, and patient-centered care.