No rapid response for a DNR? - page 2
by AlphaPig 7,232 Views | 38 Comments
This wasn't my patient, but last week on my med/surg floor a LOL who happened to be a DNR suddenly developed an irregular very fast heartrate and became less responsive. It was early in the shift, and because the patient's heart... Read More
- 3Apr 17, '13 by CapeCodMermaidThis is precisely the reason some states, mine included, are using the MOLST form....Medical Orders for Life Sustaining Treatment. The form goes everywhere the patient does and specifies ALL the treatments the person wants or doesn't fron CPR to intubation to C-PAP to dialysis to artificial hydration and artificial nutrition. A properly signed MOLST form is immediately actionable and is treated across all arenas as a valid MD order.
- 2Apr 17, '13 by SaoirseRNIt is more than reasonable to treat a DNR patient with an acute crisis if it can be medically managed, particularly if the patient's baseline involves a decent quality of life and there is a reasonable chance they could return to that with some medical intervention that does not involve CPR, intubation, etc. I think the doc was unreasonable.
I don't have a rapid response team where I work, so for above issue I would be calling a GP (unless internal medicine was already involved) and I'm sure they would want to at least attempt to treat the patient.
- 12Apr 17, '13 by DeLanaHarvickWannabeWe could take his argument even further...why even admit that patient to the hospital at all? Some people are DNRs even though they are fairly healthy - they just don't want to be coded should the unthinkable happen!
Goodness. Some people's children.
- 4Apr 17, '13 by dudette10In my workplace, a DNR means no CPR. Intubation, electrical cardioversion, antiarrhythmics, and vasopressors are considered pre-arrest emergency measures. Unless the patient/family has said no to all pre-arrest emergency measures, calling the rapid response was the right thing to do. Even if the patient had said no to such measures, I would have at least called the doc to inform him/her of the new findings.
- 7Apr 17, '13 by VivaLasViejas GuideQuote from DeLanaHarvickWannabeExactly! I had this same argument with my PCP when I asked him to sign my POLST form a few years ago when I turned 50. He didn't want to because I was "too young to be a DNR". Well, I'm here to tell you that when I no longer have a pulse or respirations, I don't want to be brought back. The form provides for different levels of treatment up to the moment of death, and sure, I want somebody to at least try to save me if I'm ill or injured; it's when my life is clearly over that I want to be left in peace.We could take his argument even further...why even admit that patient to the hospital at all? Some people are DNRs even though they are fairly healthy - they just don't want to be coded should the unthinkable happen!
Besides, as I told him, we've both been in code situations and I don't want CPR done on me. He wound up signing my DNR order.
- 6Apr 17, '13 by anotheroneDoctor sounds like a clown. Part of this is probably the patient's age too, just a guess. I have seen many pts who are DNRs and still somewhat healthy. Meaning not expected to die ANY MINUTE NOW. If a walkie talkie DNR ( have seen them) , pt had been fine all day and now temp 103.5, hr , abdomen firm, bp 80/50, hr 110 ..... should staff just ignore it ? Some doctors treat everything AGGRESIVELY. others see dnr, ( especially in elderly pts) and are lax about treating anything.
- 5Apr 18, '13 by SugarcomaThe doc was wrong. We just had a similar incident with a doc on our unit and per risk management at my hospital DNR simply refers to what measures to take should the patient arrest. A-fib with RVR is not an arrest and should be treated, DNR or not. The nurse did a good job advocating for her patient.