Question about DNR patient.

Specialties LTC Directors

Published

I have a question regarding a cancer patient who is currently on Medicare A and receiving therapy. He has been diagnosed as having lung cancer and is a DNR. He refuses hospice care. The question is when he becomes hypoxic O2 66% on 6L, T103 , BP 250/215 HR 130. Call Dr. orders state obtain hospice consult or send out to ER per family wishes. Sent to ER who immediately returns him back to the facility.

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Specializes in LTC, Psych, Hospice.

Why is the pt refusing hospice? Maybe you could get the doc to give you an order for Roxanol and transderm scop patches.

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I guess my question is if a patient is a dnr but wants to stay on medicare A for financial considerations and is not on hospice or comfort measures only then everytime his/her VS tank they should be sent out to the hospital correct because a DNR does not take effect until a person codes. As I was leaving today a nurse mentioned that he shouldn't have been sent to the hospital but I disagree.

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Specializes in LTC, Psych, Hospice.

I guess I don't understand about the financial considerations. Hospice is a benefit of Medicare/Medicaid and doesn't cost the person anything. Maybe visiting with his family will help.

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The hospice service does not cost anything but a nursing home patient would be responsible for their room and board if they did not have medicaid.

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Specializes in PICU, NICU, L&D, Public Health, Hospice.

Why is this man in a SNF? Does he have dementia or other neuro problem which affects his decision making?

A family meeting should be conducted to discuss the prognosis and goals with all players. A hospice provider could be invited to answer the family's questions about what hospice is and does.

If the patient and family determine that they do not desire hospice care and they continue to desire a full resus status, then you MUST send him to the ER when his condition deteriorates. It would be helpful to all if he had orders for oxygen prn and good pain/dyspnea control. Unfortunately, this situation is likely to end badly AND expensively.

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Specializes in ICU, PICC Nurse, Nursing Supervisor.

sounds like he needs more information on hospice....many families and patients think if you have hospice then you sign up to die in the next 5 min....however those vital signs dont look so good.....i hate to be in a situation like that ....i have experienced that numerous times and its either hospice or back to the er...you cant have a patient in your care with vitals/condition like that and not make a move either way....

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Specializes in LTC, Hospice, Case Management.
I guess I don't understand about the financial considerations. Hospice is a benefit of Medicare/Medicaid and doesn't cost the person anything. Maybe visiting with his family will help.

Hospice benefits does not cover the cost of room and board. If they qualify for medicare, the room and board is covered for the first 20 days & then day 21 and beyond they only owe 20% (most often covered with a supplemental). This may be why they don't want to give up medicare benefits.

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DNR doesn't mean do not treat.

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Specializes in PACU, CARDIAC ICU, TRAUMA, SICU, LTC.

The facility you work for should take issue with the ER to which this resident was sent. No treatment given to this severely compromised individual??? Disgusting, IMO.

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