[RN1980]

tell me why medicaid/medicare is going to pay an high icu charge for a 88yr stroked out full for the last 5yrs nursing home patient that was admitted for dehydration and pneumonia...clearly not an admission that requires icu attention and charge. got a new doc and he has to have all his dnrs up here, besides there is nothing that we are going to do to him that can't be done at a lower level of care. medicaid/medicare fraud/waste and abuse i tell you..

[meandragonbrett]

That makes absolutely no sense. Contact your hospital's medicare/medicaid office or your department chair.

[RN1980]

ahhh, our administration is so weak when it comes to confronting the doc's around here, we got a ceo thats going to retire in about 3-5yrs and he is just buying his time, does'nt want any trouble/confrontation or make anytype of thing that will rock the boat around here. worthless old coot..

[RNperdiem]

If a patient is not on a vent or vasoactive drips, they are candidates to transfer out of ICU regardless of code status. Sometimes we do have patients in ICU who are DNR. They are intubated and 1. treated just like any other ICU patient unless they go into cardiac arrest, or 2. In limbo between not going to get better, but family does not want to withdraw support.
ICU beds are not used much for comfort care only patients, though I don't mind caring for them.

[RN1980]

don't like'em don't wont'em...the last thing i need when i'm already taking care of 3 bloodsuckin patients that can very well recover if we bust our butts is a totally toasted dnr that you have to do just as much paper work on...

[SFRN]

Originally Posted by RN1980

don't like'em don't wont'em...the last thing i need when i'm already taking care of 3 bloodsuckin patients that can very well recover if we bust our butts is a totally toasted dnr that you have to do just as much paper work on...

That's the spirit!

[Conrad283]

Speak to the attending at gather his/her reasoning for keeping the patients in the ICU

But remember, DNR, does not mean DNT (Do Not Treat)

[RN1980]

Originally Posted by Conrad283

Speak to the attending at gather his/her reasoning for keeping the patients in the ICU

But remember, DNR, does not mean DNT (Do Not Treat)

please don't give me that do not treat thing, recessitation is what we do in the icu. if the patient is not going to get that, send them to lower level of care or go hospice. you'll see if you get into a unit and you got to take care of a couple real sick ones and then you have to split their time with a terminal dnr...attendings...hell he's the problem, they'll put a hypotensive dnr in the unit so the floor nurses wont be buggin him all day and night.

[delta32]

I am sorry but i am going to have to disagree with you. The only thing that the DNR means is do not restart his heart if it stops. no where is a DNR does it say no pressors or other treatment. A hypotensive patient UNLESS they are comfort care only is suppost to be in the unit. I am sorry that you feel that way about DNRs but from your post i am can't help but feel you are new to nursing or the ICU

Jamie

[Kymmi]

I agree 100% with delta32. Just because they are a DNR does not mean you do not have to address and treat any other medical issues that arise. Just last month a nurse I work with had a patient (ICU) who was a DNR however she was on a vent because the DNR was made after the intubation. The O2 sat was low and I said something to the nurse and her response was "She's a DNR so I dont have to worry about it". I went into the patients room and suctioned her and her O2 sat came up to 97%....I then went to speak to the nurse and she basically said she doesnt understand why DNR patients are taking up unit beds. I do believe alot of nurses in ICU have the completely wrong take on the meaning of DNR vs treatment.