Does anyone use a worksheet to establish a reference point of what care is to be continued or withdrawn after a patient has been made a DNR and a family meeting has taken place to establish goals of care?
We have made patients DNR and "capped care" and once that "capped care" label is in place certain aspects of patient care become inconsistent. Does anyone use a worksheet of establish care in regards to labs, cxr, abx, etc? I feel like sometimes these patients become like the red-headed step child of the unit and I am looking for a better way to collaborate care.
Does anyone have any experience with this?
I re-read your note regarding documentation for a patient or medical power of attorney who makes a decision for a NO CODE status (DNR). Inconsistencies in care may depend on the variation of Code Status from patient to patient. The doctor fills out the DNR form for Code or DNR status after an indepth conversation, full disclosure and all while assuring that the patient fully understands what they are agreeing. I have been involved DNR's status in which I had options. They are as follows: Full NO CODE: NO Defib, intubation or meds are to be administered when a patient stops breathing and has no pulse (dead); Partials code status 2. Administer meds, intubate, but no defib. 3. Meds only OR defib only OR intubate only. 4. Defib, intubate but no medications. Nurses must be familiar with each individual's code status.
When a terminal patient is noted to be at the end of life, it is recommended to involve hospice if patient decides to be a full DNR or NO CODE.
Please whatever you do, DO NOT ADMINISTER everything you've got on the crash cart to a patient who died and was a DNR. DO NOT withhold care and everything you have on a crash cart to a terminal or a patient who stops breathing and has no pulse but is a full code. Mistakes happen in Codes Blues mostly by nurses who don't know the orders. Familiarize yourself. You may get in trouble.
Last edit by t2kck on May 29, '11