We had a patient who was actively dying. The MD spoke with the family and they were deciding whether or not to make this patient a DNR. I went into the patient's room with the primary RN to see the patient; their eyes were glazed over and they were agonal breathing. The patient's extremities were warm but after some time the primary RN & I noticed that they were starting to cool down and the patient started turning pale.
The decision was made to make this patient a DNR. Now we needed witnesses; we had some family members on the unit. I had a patient with a family member in the room, so i decided to ask them. The family member was already sort of awake and I politely explained to them that we have a patient just down the hall and there was a decision to make them a DNR but we needed two witnesses. The witnesses had to be unrelated to the patient/family members and they could not be employees of the hospital.
I told the family member they weren't obligated to be a witness if they didn't want to. The family member said to me, "Oh, but I was sleeping so good, and I don't think I can make it to the room...where is it?" "Just across the hall." "Oh ok, but I don't think I could make it...." and I reminded them they didn't have to be a witness if they didn't want to, and it sounded like they didn't want to do it. Then they started talking about all sorts of other random things before finally (reluctantly) agreeing to witness.
The primary RN was standing in the hall trying to usher me out and I was trying to speed things along...I really wanted to just tell this family member, "the patient is ACTIVELY DYING and if we don't get this DNR signed SOON, we may have a full code on our hands and that would be against the wishes of the family." I then realized that could be a HIPAA violation, so I kept my mouth shut.
We finally arrived to the outside of the patient's room and almost immediately the family member said, "Oh you don't need me" and started walking back, but I told them we needed TWO witnesses, unless of course now they are not agreeing to witness. They reluctantly stayed, signed the paper and then I escorted them back to their room.
It was not like I was trying to twist this family member's arm into witnessing this DNR, but it sure felt like it. In the past I have asked visitors to witness a DNR and they have all immediately agreed to it. I don't know, I was just annoyed by it and I wanted to get this off my chest, I guess! Sorry it was long. Thanks for reading.
