question about advanced directive

Good idea to notify physician. It is his decision.

Who is POA? Is the resident making any decisions? Calling the doc is always a right answer. Remembering DNR doensn't mean do not treat. Family involvement/ interdisiplinary team is always important in these situations. What would they do at the hospital that you couldn't to in facility? Xrays? IVF? Labs?

Unless you have a specific doctor's order which says "Do not send to the hospital" you are required to call the doctor and do what the doctor suggests. The doctor usually decides who goes to the hospital and who doesn't. After multiple ER visits, it is usually the family who tells the doctor "Enough is enough. No more hospital trips for Mom." Yes you can send a patient to the hospital without the consent of the guardian. Yes a nurse can be held liable if the nurse doesn't call the doctor and lets the patient die. The only way you can let a patient die is if you have a doctor's order which says "Comfort measures only." I once had a new "dying patient" at the LTC. She didn't have her advance directives or anything like that filled out yet. I called the doctor and he said to send her to the ER. The family was "furious" and the next day all the needed paperwork was in order and on her chart.

This is what I would have done . First if this patient is actively dying someone on the previous shifts are not assessing properly. Because if it is not a MI or CVA (something acute ) the nurse should have picked up on the pt not eating and paid more attention to her decline. When I see a patient on the decline ,I discuss with the family(POA) what they want to do if the time comes whether we go to the hospital or not. If I was to walk into that situation I would have been on the phone with the family (POA) FIRST before calling the doc. Then I would have called the doc and told him/her the situation and the family wishes. The family has the authority to say yes or no to ER care.That is why they are POA. The doc 99% of the time goes with the family wishes. At this point you have covered all the bases.If the doc and POA disagree, find the Social Worker and your DON . Then you must chart, chart, chart. Nurses can ever just let someone die ,the pt needs to be on hospice or the POA needs to decline ER care. If you cant find the POA to inform them of the situation, the patient goes to the ER.