RRT on DNR

Specialties Med-Surg

Published

Last night I worked night shift on my medsurg/stroke/oncology floor. A nurse came out to the nurse's station and asked if any of the senior nurses were around. I said no, why? She said I think my patient is dying. I said is she a DNR? Is she comfort care? She's like she's a DNR and they were kind of expecting her but not so soon. I said oh and we ran back to the room. I walked in and she was unresponsive agonal breathing HR in 30s and I asked do you want a RRT? I knew nothing about the patient besides she was a DNR? The nurse looked at me and then she said ya. I called a RRT and when they showed up she had already passed. The nurse had sat on her for over an hour "while she was on her way out." As she called it. The RRT team was like why would you call a RRT on a DNR?? It was a change in patient status and her RN told me to. The RN blamed me. And said I called it. I told my manager about the situation. Just because she's a DNR doesn't mean you don't do anything. Did I do something wrong??? The nurse is notable for not being competent i knew nothing but the patient was all but passed when I walked in.

Some people are DNR but not DNI (thinking of chronic COPDers for example). Who comes to the RR? We have an ICU doc, pharmacy respiratory, and hospitalist. Everyone can look at the patient together and see if there is a non-CPR intervention that can help the pt through that particular issue.

Specializes in Medical-Surgical/Float Pool/Stepdown.

I agree with most of the PP's that just because a patient is a DNR does not mean they don't deserve a code called for emergent supportive care. There are tons of things that can be done to support better patient outcomes when calling a code that have nothing to do with chest compressions or being intubated! It would be very short-sighted to not realize that a much needed IVF bolus or other less invasive supportive intervention could have been done but wasn't offered to the patient just because they were a DNR. Just think of a DNR being very different than a comfort care patient just like hospice is very different than palliative care. This is a prime example of why lay people are scared to be organ donors because they think if they're ever in an MVA the first responders/ED will just not treat them because their organs would be more valuable to patients on waiting lists instead! :nailbiting:

Specializes in Med-Surg.

I don't even understand why you are being questioned on this. Of course you can and should call an RRT on a DNR patient when appropriate. You did the correct thing!

I have had fairly healthy patients in their forties say they want to be a DNR for whatever reason. So if they start swirling the drain, am I supposed to pull up a chair to watch and wait until they die since they are a DNR? That's ridiculous. People choose to be DNR for many different reasons and DNR patients can still benefit from rapid response interventions.

I called a RRT recently on a DNR patient. It's a long story but basically the patient needed one specific intervention STAT and the physician did not respond to my page quickly. The situation got worse so I called a RRT. The team who responded were polite and understanding. The patient got the intervention and lived. I don't regret making the call.

You can stand up to your coworkers and I hope your manager backs you up on this.

DNR does not mean do not treat. Any doctor or judge would agree if family sued.

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