Can you choose DRN and full treatment in the POLST?

[Leonardo Del Toro, RN]

 

OK. This is weird and at first seems obvious but I'm confused about this one. A patient wants to be DNR but she also wants to choose section B item "full treatment  trial period of full treatment. OK it doesn't make any sense right? But if you read above it says "if patient is NOT in cardiopulmonary arrest, follow orders in section B and C. 

Meaning: I don't want CPR if I'm not breathing but any other situation I want to be taken to the ER for treatment?

[LibraNurse27, BSN, RN]

I think that's what it means. I've had some patients like that who wanted to do everything up until the point of a code, even if they had been recommended hospice and told that further treatment would likely be futile. I can't judge because I have no idea how it feels to be diagnosed with a terminal illness and have to make these decisions, but I do try to help patients make decisions that will maximize quality of life and minimize pain and suffering. 

[MunoRN, RN]

You can choose "DNR" from part A, and "Full Treatment" from part B.  It's the other way around that doesn't really work: Full Code in part A but Comfort Measures only in part B.  As it points out at the top of the POLST, you can only choose "Full Treatment" in part B if you've chosen "attempt resuscitation / CPR" in part A.

 

[Leonardo Del Toro, RN]

19 minutes ago, MunoRN said:

You can choose "DNR" from part A, and "Full Treatment" from part B.  It's the other way around that doesn't really work: Full Code in part A but Comfort Measures only in part B.  As it points out at the top of the POLST, you can only choose "Full Treatment" in part B if you've chosen "attempt resuscitation / CPR" in part A.

 

In my 10 years of nursing I've never had a person requesting this. I was told by some MD and DON that this is not allowed. But I can't see any reason why this is not allowed. However this is beyond my scope of practice. I'll let her MD decide...thanks

[JKL33]

Section A states that it is to indicate what they want done if they have no pulse and are not breathing.

So if your patient is in full arrest s/he does not desire any efforts to resuscitate.

If s/he is not in full cardiopulmonary arrest then a trial period of full treatment is desired.

 

13 hours ago, Leonardo Del Toro said:

Meaning: I don't want CPR if I'm not breathing but any other situation I want to be taken to the ER for treatment?

No, it specifically says if not breathing and no pulse. Patient doesn't want CPR if they aren't breathing and have no pulse. That's all it says.

 

10 hours ago, Leonardo Del Toro said:

I was told by some MD and DON that this is not allowed.

Their conclusion doesn't make any sense.

[Leonardo Del Toro, RN]

2 hours ago, JKL33 said:

No, it specifically says if not breathing and no pulse. Patient doesn't want CPR if they aren't breathing and have no pulse. That's all it says.

That's what I was trying to say. Allow natural death if not breathing. But if patient has a pulse and is breathing but say, not responding or any other s/s of life threatening distress, than pt has the option of other interventions...sec B,C

[hppygr8ful, ASN, RN, EMT-I]

Just remember that DNR does not mean do not treat! Will explain later as I am getting ready for work.

hppy

[JBMmom, MSN, NP]

The missing piece in all of these papers in the intubation piece. Because DNR does not mean do not intubate. We end up with people in the critical care unit that want no compressions but will accept "trial intubation" if in respiratory failure. (but the trial intubation part always confuses me because there are no parameters defining trial. Do you try it for 12 hours? Two weeks? What's the end goal?) So many of these concepts and conversations around them are done so poorly with patients and families it really can cause so many problems. 

But as to the original question, I agree with the interpretations above- pulseless and not breathing- no CPR, everything but pulseless and not breathing, do everything. It's an appropriate treatment request. 

[Emergent, RN]

The patient wants to be treated, but if their heart stops, or they stop breathing they don't want CPR. They do want fluids, antibiotics, and other treatments. What they don't want is to have their chest pounded on and to have a tube stuck down their trachea.

[VivaLasViejas, ASN, RN]

My POLST is very clear: if I’m not breathing and have no pulse, I don’t want CPR. If however I still have a pulse and am breathing, I will allow some limited  treatment unless/until it becomes evident that I won’t make it. Then it’s comfort care only. And for the love of God, don’t attempt to prolong my life artificially with feeding tubes and mechanical ventilation. If it’s my time to go, it’s my time to go.