DNR patient coded

[adventuregirl, MSN, NP]

My patient today was a 93 yo women who had a pacemaker placed several days ago. She arrested on the table and 10 minutes of CPR was performed, and she was vented and sent to ICU. She is now on my step-down/tele unit, 5 days later. She has fractured ribs, a feeding tube, is very frail and weak, and needless to say, uncomfortable. I found out after my shift that she had signed DNR orders, as well as a DNR colored hospital braclet, prior to having her pacer placed ... in other words, everyone should have known she was a DNR. The nurse who informed me of this said Dr's don't like their patients to "die on the table", so they coded her. Has anyone heard of this happening? How can this be prevented? I fear for myself, and my own family going through this type of pain/suffering if my/their wishes are already expressed, and the Dr is aware. What does a person need to do to make sure their wishes are met?! I feel so sorry for this lady. I'm not sure the daughter has any interest in taking legal action, but what could be done if this was the case?

[nrsang97, BSN, RN]

There was a patient recently in the SICU where I work who was in the OR and not doing well so they stopped and brought her to the ICU. She stayed overnight and then went to the GPU for hospice. Pt was placed on a morphine drip. Pt was extubated in the ICU and not recovery also.

The doc would not have operated on her if the pt and daughter (or daughter if pt not able to decide for herself) for her to go to the OR as a DNR. So now after OR she should have returned to DNR status.

I am sorry your patient had to experience this.

[EmmaG, RN]

In every facility I've worked (trying to recall any exceptions, and I can't...) DNR orders are suspended for OR.

Check your hospital's policies, and read through the anesthesia and OR consents. There may be a specific consent for this (we had a separate one for suspension of DNR status that had to be signed along with the others).

[adventuregirl, MSN, NP]

Wow, I was not aware of this, along with other nurses I've spoken with. I will definitely look into this! If this is the case, I'm not certain the patient was aware that DNR is suspended in OR.

Thanks!

[EmmaG, RN]

After reading the first link, I suppose my hospital has informed suspension of DNR, since they have a specific consent for that purpose.

http://www.anesthesia-analgesia.org/cgi/reprint/80/4/806.pdf

http://www.aana.com/resources.aspx?ucNavMenu_TSMenuTargetID=51&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=709

http://findarticles.com/p/articles/mi_m0FSL/is_2_76/ai_90749849/pg_2

[EmmaG, RN]

Wow, I was not aware of this, along with other nurses I've spoken with. I will definitely look into this! If this is the case, I'm not certain the patient was aware that DNR is suspended in OR.

Thanks!

Check your policies; I've worked in about 8 facilities over the past 5 years or so (as a "regular" staff nurse then as a traveler). All of them had some form of this policy; from the links I posted above, not all hospitals do.

[UM Review RN, ASN, RN]

Ours does suspend DNR for the OR as well.

So sad about your patient.

I guess I'd question a person of that age having a pacemaker placed, but I guess we all secretly hope to live forever, don't we.

[RNontheroad]

I never realized that this was the policy at some hospitals. It's not really something you think about until it happens, like it did to your little lady.

Thanks for sharing and making me aware.

[loricatus]

Same here, regarding suspending DNR orders while in the OR. As I was told when I questioned this, the answer was that-"ever wonder why nobody ever dies on the table and a code is never called in the OR?"

[nursemary9, BSN, RN]

In every facility I've worked (trying to recall any exceptions, and I can't...) DNR orders are suspended for OR.

Check your hospital's policies, and read through the anesthesia and OR consents. There may be a specific consent for this (we had a separate one for suspension of DNR status that had to be signed along with the others).

The same is true in all the Hospitals I have worked in.

[RainDreamer, BSN, RN]

Where I work, the DNR goes out the window when the patient goes to the OR or has any type of surgery in the unit.

I think that's standard policy .... if someone is willing to go through life-saving measures (i.e. surgery), then why would they want to be a DNR?

[canoehead, BSN, RN]

I think that's standard policy .... if someone is willing to go through life-saving measures (i.e. surgery), then why would they want to be a DNR?

For comfort, like tumor debulking, or hip pinning after a break. I wish suspended DNR's were not co common in the OR. It would at least be a peaceful death.