Liability issue

Crocuta, RN · Dec 14, 2006

Unless a patient has been declared not competent to make his/her own medical decisions, they have *every* right to refuse any and all medical care.

Document, document, document.

Document patient s/sx, treatment given, doctor notification and any orders received, recommendations to be transferred to hospital. Document patient refusal for care *with quotes wherever possible*. Have someone else there when the patient refuses and document that. "Pt states: 'I'm not going to the hospital and you can't make me.' with Janie, RN and Billy, LPN present." I would redocument frequently your continued recommendation and the patient's continued refusal. Document any contact with family members if patient has given advance permission to share health information.

You may end up in court if the patient dies, but if your documentation shows that you exercised appropriate care, you can't get in trouble for honoring a patient's wishes. On the other hand, you *can* get in trouble for forcing care on someone who is competent and doesn't want the care. If your documentation is sloppy, you may have a hard time proving to a judge what the patient did. Don't ever leave room for a lawyer to make your documentation look like something else happened than really did.

If the patient has given DPOA for health care to someone else, then they get to make the decisions. Follow their directions.

AnnieOaklyRN, BSN, RN, EMT-P · Dec 14, 2006

I work on an ambulance and have had this happen a few times, not often though. From the paramedic point of veiiw if the patient is Alert and oriented x3 we cannot force them to go to a hopsital if they are refusing as that is illegal and we can be charged with battery and taking someone against their will!! Some nursing home nurses, and even people who call us from home think that we can take the patient because THEY want them to go, but its about the patietn and whether the patient wants to go, and again we cannot take someone against their will unless they are really confused.

Swtooth

gitterbug · Dec 14, 2006

Document, document, document. Make sure every staff member who heard this patient refuse care is documented, ambulance staff too. If the family tries to file a suit for lack of care you want every base covered. It is true, if a person is competent,as deemed so by the state, care cannot be forced on them.

babynurselsa, RN · Dec 14, 2006

Code status does NOT supercede an alert competent persons wishes.

Document all conversations, orders, responses and patient responses.

I too ama big fan of a witness and quotes.

You may need to advice family of the situation, but stress to them that you cannot force the patient to go to the hospital.

SueBee RN-BSN · Dec 14, 2006

hello
what happens if patient is full code, but refuses to go to the hospital? is this putting the facility and nursing licenses on libility? if a nurse calls a doctor, let him know of situation and document that patient is refusing to go to the hospital but if patient dies, are nurses protected or can they lose license? :smilecoffeeilovecof

if a patient is in a full code, he/she is not competent to make any decision about their care. unless they have a living will, or they are a documented dnr. never just take someone's word about these legal documents.

marjoriemac, LPN · Dec 14, 2006

We had a lady recently who was having chest pain not relieved by GTN, her doctor said to call an ambulance and when it came she refused to go. As it happens, this lady is the 'lady who cried wolf' and it was a false alrm, but nonetheless, the key was to document everything and the paramedics also made her sign a form stating she refused to attend A&E.

AnnieOaklyRN, BSN, RN, EMT-P · Dec 17, 2006

umm LOL sue bee I think you misread the post. The patient was not IN cardiac arrest, they were just refusing to go to the hospital and were full code status (not a DNR).

Daytonite, BSN, RN · Dec 18, 2006

What happens when a patient is a full code but refuses to go to the hospital?

You can't force the patient to go. Document what the patient says and does and notify the doctor.

Is this putting the facility and nursing licenses on liability?

No, not as long as you document. Also, if there is any facility policy regarding this, it should be followed to the letter.

If a nurse calls a doctor, lets him know of the situation and documents that the patient is refusing to go to the hospital, but the patient dies, are nurses protected or can they lose their licenses?

This patient is a full code, right? Then, when the patient becomes apneic or pulseless, code blue protocol should be instituted immediately as per facility policy. If that includes calling 911, then that is what needs to be done. As long as that occurs, no ones license is going to be in jeopardy. If, however, the patient, who is a full code, is allowed to die and nothing is done, the nurses will have to answer for why nothing was done for him when he became incapacitated.

When I was a nurse manager in an acute hospital something like this occurred, where a patient coded and the nurses in attendance did not call a code blue thinking that he was a DNR. They wasted a great deal of time trying to find a written DNR order in the chart that just wasn't there. A nursing assistant who was also in attendance finally picked up the phone and notified the supervisor on duty of what was going on. A code blue was immediately called by the supervisor who was on duty. The patient ended up dying. The two RNs and LPN involved were suspended and the DON was considering reporting the licensed nurses to the board of nursing for failing to start CPR and call the Code Blue.

CapeCodMermaid, RN · Dec 19, 2006

If the patient's status is FULL CODE and they are awake,alert,and oriented, of course they can refuse to go to the hospital. However, if you find them pulseless 5 minutes later, you'd better call 911 and start CPR.

Make sure you DOCUMENT everything. A facility I worked at was sued by a family because the woman died of pneumonia. The nurses recommended to her that she go to the hospital(many co-morbidities)...she refused...she died...they were sued....they lost because even though we all remember that she refused to go, the nurse on duty at the time did not document that refusal....yikes!

PS. The woman refused O2 which WAS documented and continued to smoke like a fiend despite 02 sats in the mid

80's (!) and the family still won.

CoffeeRTC, BSN, RN · Dec 19, 2006

Has the resident considered changing their code status?

Sometimes it just depends on the reasoning or current problem. I've had lots of full code pts that refused to go to the hospital. For example..maybe the doc wanted them to go for xrays, iv or labs in the evening. Full code, A&Ox3 refused and said..I will wait till the am. Document that. Now if that resident went unresponsive etc...yep...the full code status stands and they are going out.