48 Hour Wait Time Once DNRCC Order Initiated?

[CCUnocRN]

Recently our hospital system has stated that once a DNRCC order has been written (changed from a Full Code or DNRCCA), we now need to wait 48 hours before withdrawl of ventilator, vasopressors, LVAD, etc. (anything already in place, we cannot change) The entire time years that I have worked here, we have done things differently. Once the family/patient decided to change the code status to DNRCC, we ususlly began our comfort care protocol (morphine for pain/ativan for restlessness, etc) and started weaning down the vasopressors first. If their BP was only marginal with vasopressors, this was usually all that we needed to do. We had the family there in the room and provide emotional support and spiritual support.Now, once the family wants their loved one to be a DNRCC, we have to wait 48 hours before doing anything with the current life-sustaining measures. An example that happened to me recently: an elderly pt was sent from one of our outlying hospitals on the vent, neo/levo running, and with an LVAD. They arrived to our unit around 2pm and I came on duty at 7pm. They had placed the comfort care orders on the chart "except: ventilator, LVAD, neo and levo. This seems to be conflicting. The LVAD started alarming because the patient was deteriorating, and the LVAD couldn't do it's job. The physician stated to just turn down the P level on the machine. I called the rep and he stated that I could just keep turning down the P level. After I couldn't turn it down anymore, the Impella started alarming obnoxiously "Suction Alarm". I called the physician and explained that since it wasn'table to function appropriately, could I turn it off? He replied "No." I called the rep and he told me how to disable the alarms. Which I did.So, I've got life-sustaining measures that are clearly not effective to run for 48 hours, but also comfort care orders in which I am giving morphine and ativan. The patient's family also frail and elderly, were in the room. They had to listen to alarms and was also worried about respirations between the ventilator. The hospital ethics committee has stated that we have just been misinterpreting the law all of these years, and now we are following the law. I have read and reread the state code and I am not seeing where this is the case. It seems to me that if the patient had told the spouse their wishes, and the spouse says DNRCC, we should be able to comply with their wishes and begin the comfort care protocol asap including the withdrawl of ineffective life-sustaining measures. If anyone could respond with helpful info, I would greatly appreciate it. Thanks!!CCUnocRN

[apocatastasis]

I'm not sure of yourlaws, but I can't see the reasonableness of waiting 48 hours if that is the law. The policy itself is ridiculous. If I had a family member in ICU and I were power of attorney, and I sign the DNR and say to extubate and stop pressors, you extubate and stop the pressors. No way would I pay for two extra days of a (probably already crazy expensive) ICU stay because of "hospital policy."

Was there any particular reason for the change that you know of?

[CCUnocRN]

We were told that Our state had always had that law, but it had been misinterpreted. The Ethics Dept and the institution says that this is the correct interpretation.