"Capped Care" in the ICU
- 0May 22, '11 by micker14Hello All,
I work in an oncology ICU/SICU. I am wondering how other units handle "capped care". I am finding that after a familiy meeting where a DNR is obtained and "capping" care is discussed there seems to be confusion from shift to shift or day to day amongst staff as to what we are actually continuing to do or not do.
Is anyone using a standardized policy to help keep everyone on the same page? I thinking of just using a worksheet or something that will be filled out once the "capped care" discussion takes place so there is always a point of reference.
Does anyone have any experience with this?? Please respond! I need to present this to my nurse leader!
- 0May 22, '11 by I_See_You_RNNo we don't have that in my ICU. I work in the SICU and I get very few capped care orders. Its usually treat, treat, treat and if nothing works they either expire very quickly on max doses of pressors/etc., a failed code, or they get transferred to palliative. However, when I get floated to the MICU I have run into the problem of what they meant by 'capped care.' Are fluid bolus'/ blood products included, etc.? I think that sheet is a wonderful idea and would like present it to my unit if its not there already, or revive it if the case is that its just not being used.
- 0May 22, '11 by ICUenthusiastCan you explain what capped care can include? I think the most my hospital sees is DNR+DNI (do not intubate), and then ofc the standard "are you against receiving blood products in the event you need a transfusion" which is aimed more for religious beliefs than capped care.
- 0May 23, '11 by umcRNI work in a NICU and we have a "limitation of care' order that is written by the physician after talking with the baby's family. It can say anything from DNR/DNI/AND (allow natural death) to being a "limited code" in which case it is spelled out in terms ie: do not intubate but can clear airway/suction/bag, or some may have no compressions but CAN give epi, or no compressions/no code drugs but can give fluid/volume expanders, and on an on to basically whatever the family decides on, and this can be changed as time goes on. Whatever is decided is clearly written in a physicians orders and is always passed along in report. Also, our allow natural death babies/full DNR babies will have a butterfly taped up to their monitors so anyone responding to an alarm will realize not to hit the code button if that is whats happening
- 0May 24, '11 by FunRunI too have never heard the term "Capped Care", can someone explain? Interested to know :-) I work in a Cardiac ICU and when there is a decision to change our goals or not move forward with care there is a very specific conversation had with families/patients and then a very specific order is written and everyone on the team is aware of the plan. Communication is so important and it is sad to hear that sometimes nurses are unclear. My advice, if there is ever a question go up the chain of command until you find answers. It is our job as nurses to make sure we are carying out the wishes of the patients and families we care for. This is a tough issue and it is even tougher when everyone is unclear of the plan. Hope this helps...
- 0May 24, '11 by I_See_You_RN"Capped"
I've had pressors capped before hitting max dose,.. no more blood products, no compressions, pain/anxiety medications only.
I've always found it humorous (for lack of a better word) when I'm doing "capped care" / terminal weaning and they forget to d/c protonix or juven or nystatin .
- 0May 24, '11 by micker14Thanks for all the responses! In our unit capped care is just after we talk to the family and we let them know that its a poor prognonsis and we are not adding to the current treatments in place.
I was just wondering if anyone had a standardized order form to keep all team members on the same page. I love the butterfly on the monitor idea! That is great. I may suggest that for our ICU. So many great suggestions! Thanks All!