Tamara J.

Putney, RN Chair, Critical Care Nursing Council Munson Medical Center 1105 Sixth Street Traverse City, Mi. 49684 October 16, 2012 Dr. Joseph Will Chief, Medical Executive Committee Munson Medical Center 1105 Sixth Street Traverse City, Mi. 49684 Dear Dr. Will and Members of the Medical Executive Committee: As with many complex issues involving patient care, challenges will be encountered in which people will have contrary views. Having family present at the bedside during cardiopulmonary resuscitation is one of those complex and controversial issues. Serving our community and ensuring safe, quality patient care is our number one goal. We continuously strive to serve the best interest of the patient and promote the best possible outcomes with our care. After a hospital stay, it is policy to send every patient a satisfaction survey, as a means to evaluate the care delivered. Recent surveys reveal families and patients are expressing the desire to actively participate more in care decisions. Specifically, families are expressing a strong desire to be at the bedside and be involved in decision making during cardiopulmonary resuscitation. We recognize there are many points of contention among the medical staff concerning this subject. Some providers are concerned that family members witnessing resuscitation would develop lasting negative impressions of the hospital care delivered. Many health care providers have also expressed concerns about possible legal ramifications related to patient outcomes or performance issues. While still other physicians have commented that it is hard to make decisions, express feelings, or consult team members during a code blue with family members present in the room. We appreciate your concerns. Many hospitals nationwide have adopted family presence during resuscitation guidelines, as endorsed by the American Association of Critical-Care Nurses, American Heart Association, Emergency Nurses Association, and the Society of Critical Care Medicine. Caring for the emotional health of patients and families, and promoting the ability of families to achieve closure or resolution in response to difficult medical situations and outcomes is imperative. It cannot be assumed that family members will be impacted in a negative way by watching bedside resuscitation. Studies have shown both negative and positive effects on staff and family. Studies also show the outcome of the resuscitation can have a positive impact on the grieving process, because family members are able to see that staff did all

Dr. Joseph Will January 27, 2013 Page 2 they could to save the life of their loved one. One American Journal of Critical Care Medicine study revealed that 89% of families reported that being with their loved one in this situation was helpful to them, and 95% reported they would do the same in a similar situation. Our health care environment is changing; families and patients are demanding more involvement in care and decision making. In conclusion, there are many factors to consider when deciding if family presence at the bedside during cardiopulmonary resuscitation is appropriate. Not all family members will be suitable to place at the bedside, and not all situations will be appropriate to be witnessed. Care providers, family members and patients must be taken into consideration. All options must be weighed, literature must be reviewed, and policy guidelines must be clear. Understanding that you may still have reservations, we would appreciate a meeting to explore any options available to facilitate a compromise. Keeping the best interest of the patient our top priority, our goal is the development of a protocol that could be utilized quickly in the appropriate situation. We look forward to hearing from the committee. Thank you for your time and consideration,

Tamara J. Putney, RN Chair, Critical Care Nursing Council