"no further hospitilization" order

[ktwlpn]

Have you ever seen "no further hospitilization unless extreme distress" orders in LTC?

[Noryn]

My state which is WV has done a wonderful job with advance directives. Here is our official POST form

http://www.hsc.wvu.edu/chel/wvi/_pdf/POST_Form_2006_Sample.pdf

It specifically mentions what the pt and family want. A simple DNR does not mean do not treat but this form which is required states exactly what the family wants. Hospitalization, antibiotics, etc. There should be no confusion with this form because it specifies what it considers are heroic measures.

[CapeCodMermaid, RN]

Massachusetts does not accept a Living Will. We have DNRs and some patients are very specific about what they want. We have a hospice who will admit a patient who is a full code. I am very comfortable talking to families about end of life care. Why send someone to the hospital to die with strangers when we, who have known them for years, and have cared for them and about them, are capable and competent to keep them comfortable. Put this way,most families see the benefit of keeping an end of life patient at the facility.

And, for the folks who are ready to die but need treatment, we do every thing we can to keep 'em in the facility. It's traumatic to have to get shipped out to the hospital...the ambulance ride, the strange people, the pressure sores, the haldol, the restraints.....far better to keep them in our facility and treat them at 'home'.

[sharlynn]

i have seen "do not hospitalize" orders written in keeping with family wishes

so have i. also "no antibiotics per family request"

[noc4senuf]

We also use "do not hospitalize" orders in our facility. Some times an additional phrase of "unless a major fx" is added. We utilize "cpmfort cares', "pallitive cares", and our own hospice. We have not had an issue with uncontrolled pain as we are able to keep it under control with the use of oral meds, Roxanol, duragesic patches, even cadd pumps. Our main goal is to keep the resident comfortable along with they and the family's needs and wishes met.

[CoffeeRTC, BSN, RN]

Even with these "no hospital transfers, comfort measures only" orders, you still call the family and if they want to change their minds, they can. Frustrating at times.