The Dreaded Death Bath and a Moral/Ethical Dilemma?

OOPS!! Typo!

My hospital is a level 4 trauma center. I'm in the MICU. sorry about that!

This was an excellent post!!!


I would hope that the vital signs and required aggressive therapies alone would demonstrate why the patient could not be turned frequently. However, my guess is that CMS will require some sort of form and official documentation of stated reason why it was not done-- despite the obvious evidence of vital signs, etc.

Another fact that has bothered me since the institution of "never events" and "pay 4 performance" is that some factors, not related to nursing care, impact these outcomes (extraneous variables). For example, in your patient who was so horribly hemodynamically unstable- not only was perfusion to his vital organs lacking, but to his skin as well. What do they expect from us? Magic???? Then if you looked at his nutritional status and immune status before arrival to ICU, it probably plays a part as well....

Reminds me of the night we had a patient go into SVT or A-Fib, can't remember which. HR was 180-200. The nurse was in the other room silencing the alarm on her other patient's monitor, never mind going into see the other patient. Oh and after we got the patient's HR stable, she wanted the CNA to help her bathe him. The CNA refused. I would have too.

Anywho, if my patient is hemodynamically unstable they don't get turned.

Since the percentage increase from resting SVO2 in bathing is the same as in visitation (22% vs 23%) could an argument be made that limiting visitation is BENEFICIAL in some patients?


http://books.google.com/books?id=_vW...esult&resnum=9

Ahhh, the "death turn".... I know it well. Or how about the ones that drop their pressures and desat simlpy at the sound of the portable XR rolling by their door???

Fact is some patients do not tolerate stimulation of any kind- 5 pressors, open chest, CRRT, ECMO -whatever.... you just cannot turn some of them, and forget about a bath. I guess if they survive, a pressure ulcer might be the least of their concern.

Like another post said- sometimes I do think they expect "magic".

This is before I worked in ICU...


There was a pt who had been at one point so unstable he could not be turned. So he ended up with a large pressure ulcer on his buttocks. He had a traumatic brain injury, among other things.

I was his nurse on the ward when he transferred out of ICU.

I just remember his wife thinking we had taken a chunk out of his a$$ to fix his brain. (That was exactly how she said it!)

Still makes for funny memories, all these years later!

This relates to a question I asked my manager a few months ago. Not about the ethical piece of it, but the reimbursement piece: If a pt who is A&O x3 refuses to be turned, do we still get reimbursed if s/he develops a decubitus? Pt was unable to move himself but refused us to turn him. So will CMS pay? Us? The pt?

Never got an answer, BTW.

I think the fatal factor involves baroreceptors. IME it it soooo not necessary to bathe a patient who has no reserve. If you turn a patient and he de-sats or drops his pressure precipitously---STOP!!
I have participated in what one might refer to as "benificial patient negligence" more than once.
COMMON SENSE, people. Sheesh............
Another suggestion: get a "DO NOT TURN" order from you MD's. I've done it. CYA to the max.

Maybe it's just me, but I don't take reimbursements into consideration when I'm caring for my patients. If they can't handle a turn or bath, they don't get one. However, I do document as such and pass on in report so no one thinks I'm being lazy or forgot.

I would think that if the facility adequately documents it, maybe MD orders like the one poster had, insurance can't refuse to pay.

Great post. I am a new grad. I will be starting in the SICU on monday. I did my capstone in the MICU. My preceptor ALWAYS bathed and turned the patient....even when there were 9 drugs going in, vent, CRRT, multiple organ failure. Was she wrong?