DNH order, LTC???

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Hey guys i have a really important question to ask, i have been working at this nursing home for a couple of years now and just got a resident who's 90 years old and has DNR orders in place, he's also comfort measures only, but does not have a specific Do not hospitalize order, anyways, this patient all of a sudden collapsed today, by collapsed i mean, he lost conscieousness all of a sudden, was lowered to a floor by a CNA, and when we checked him he was still having pulse and respirations, very labored, but his pupils were not reacting to light, anyways, he didn't quite code, but just had a very sudden change, so we sent him out to the hospital ER before we could get a hold of his family or doctor, i called them, but they didn't respond right away and it was a matter of minutes, we had to make a decision what to do. He'd have coded had we not called, anyways, myself and the other two nurses who were there just got suspended for calling the hospital, we are in CO, i was wondering is it legitimate? i mean i've never had a situation like this before, but i always thought that DNR does not stand for do not treat and i had a right to send resident out if something like this happened, but our administration says if his MOST form included comfort measures only we had no right to have sent him out unless the MD or the family said we should, but then the family or the MD were not answering phones !!! what do you do in this situation? i think comfort measures do say somewhere in the form do not hospitalize for life sustaining treatment, or something like that, i should have made a copy of it, but now i'm suspended. I feel it was the most unfair thing to do to us, i felt like we've actually saved a life, and the family had no complaints about it, so i dont understand our administration, does anybody have a similar experience?? i would really appreciate your advice!!

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Specializes in Gerontology, Med surg, Home Health.

If he had a MOLST that specified NO hospitalization, you should not have sent him out. It's that simple. That's why the MOLST is such a good tool. If he only had a DNR and you couldn't get a call back from the family or the MD, you did the right thing by sending him. Regardless, being suspended seems like a very harsh punishment when it seems from your post you were trying to do the right thing.

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comfort measures states do not hospitalize for life sustaining treatment, we were mainly sending him out for a general check up to see what was wrong with him, and he didn't have any strict do not hospitalize orders signed by family, only general recommendation to leave it up to a proxy/ family in case something happens, but since the family was not responding on the phone, what we were supposed to do, and thank you for your sympathy, i thought it was a little harsh also ))

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Pupils not reacting, labored respirations, you also stated he was likely to code if he wasn't sent out. Sounds exactly like he was being sent out for life sustaining treatment. Whether the punishment was harsh is neither here nor there; it's important to recognize that you did not follow his treatment plan and accept the consequences. I agree that DNR does not mean "do not treat" but "comfort measures only" "do not hospitalize for life sustaining treatment" are what indicate he should not have been sent out, not the DNR.

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His POLST is not black/white and has quite a bit of room for interpretation. Before my grandma passed away her code status/wishes were very specific. DNR/DNI, No hospitalizations.

This man did not code and you did not initiate CPR. He was comfort measures only but showed signs of distress/discomfort... And the family did not file a grievance... I think you and the other nurse used your nursing judgement in a sticky stituation and erred on the side of caution... I think administration is wrong.

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oh thank you JoAnna78, i mean i guess if i'm wrong i'm wrong, i don't mind admitting my fault, but in this situation i also think that it's not black and white and i'd rather be on the side of caution and save somebody than let them die and then have regrets about that.. anyways, i guess in nursing there are a lot of situations when you have to apply your critical thinking, when you are not quite sure about how to act, this is one of those.. thank you all for your advice!!..

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I would think that your facility should have clearer protocol for situations like that. It seems harsh to be suspended. Hopefully the policy gets cleared up. I would think if the family isn't upset you should be allowed to get back to work.

I'm a new student, haven't started my nursing classes yet though I worked as an LNA. When you have only a DNR on file does that encompass performing the Heimlich maneuver as well as CPR?

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Specializes in Gerontology, Med surg, Home Health.

DNR Do Not Resuscitate. If you find me in my bed and I am pulseless and not breathing, do not start compressions. We try to explain it as simply as we can to residents and their families.

The Heimlich maneuver isn't part of a DNR order since if I'm choking, chances are I still have a pulse.

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Specializes in LTC, Memory loss, PDN.

my first reaction, after reading the op, was i would not have sent the pt. to the hospital

after reading the CO specific MOST form, i'm sure the pt should not have been transferred

because the form specifically says for comfort measures only the person should not be

entered into a trauma system and the op states he was sent to the ER

the form also states that EMS should contact medical control before transporting

so the question arises was this form presented to EMS or did EMS drop the ball as well

at any rate, administration is correct in that the nursing staff erred

it is, however, sad and counterproductive that admin chose to come in with an iron fist

rather than recognizing the need for training as well as providing such training

as it is, there is still uncertainty and the distint possibility for errors in the future

as often is the case i'm left wondering what did admin hope to gain by suspending staff

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Specializes in LTC, Sub-Acute, Hopsice.

Very simply, if he was not to be sent to the hospital, he should have had a DNH order. In the middle of an emergency you don't have time to read POLST forms. That's why we have DNR, DNH, DNI orders. And with no way to speak to a family member or MD, what else were you to do? And I agree that suspension was WAY harsh. Your director obviously doesn't see a need for education, which makes me question her ability to adequately lead a team.

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Specializes in LTC, Memory loss, PDN.

it wasn't an emergency

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