I had a pt who had been NPO due to swallowing issues and aspirating. No one can figure out why this patient has swallowing problems since he did not have a stroke. When the pt was initially admitted he was in the ICU and the neurologist told the family he would come around and he has made tremendous improvement compared to what his initial condition was when he came in. On the day I had him he was oriented and this was the first day out of 10 days that he was oriented. He did say bizarre things but I don't know if any of that could have been due to the fact that he has schizophrenia.
The bottom line is his swallowing and aspirating. On the second day I cared for him I received an order from a doctor to order a pureed diet and thickened liquids as long as the patient/family understands that he can aspirate and die. I repeated the order back to the doctor and told him I was writing the order exactly as I read it back to him. Well I knew if I talked to the patient he'd want to eat. I called his 2 daughters and the first daughter deferred to her sister since she is a nurse. I talked to her and she said she didn't feel comfortable with proceeding with feeding him. She has actually been waiting for the psychologist to write a letter stating if the patient is competent to make decisions on his behalf or not. I contacted everyone I could think of - my nurse manager, the primary doc/physician assistant, speech therapist, nutritionist, and case manager. Basically this gi doc feels like he can't do anything because the patient is flat out saying he doesn't want a feeding tube and he can't eat. As soon as the doc came up I made him sign this order that I took so I feel like I am covered. I also documented my conversation with the daughter.
I just don't agree with this and don't know what else I could've done. Have you ever received an absurd order like this before?
