DNR pet peeve

Nurses Activism

Published

I am so annoyed with doctors and nurses who don't understand the difference between DNR and palliative care!

It scares the wits out of me when I've had a patient who is DNR and the MD drags his feet to treat a patient for something TOTALLY treatable. An example is a patient spiking fevers and incr WBCs (admitting dx completely nothing to do with it) and the MD doesn't think it's worth investigating a source of infection and just treating it!!

Or an RN who exclaims "she doesn't need to be on telemetry then!" when I give report that a DNR patient is on cardiac monitoring. We had a healthy argument where he insisted that he shouldn't waste his time observing heart rhythms if the patient is DNR. Meanwhile the patient that day went into SVT (again, unrelated to admitting dx) and we converted it and went on with our day. Why SHOULDN'T you fix what's fixable??

DNR does not mean withdraw care! A family made a painstaking decision to not resuscitate their relative in THE EVENT that it could be required. They TRUSTED us with this delicate situation and in return we are distorting their intentions into something that is more akin to just neglecting their loved one altogether!

Really makes me think twice about a DNR order for MY family.

I feel guilty because I completely understand health care workers initial reaction...."Why are we transporting her....she is a DNR........why are we putting her on telemetry....she is a DNR.". Simply replying "Yes she is a DNR, not a do not treat." will hopefully impress the health care worker with what the patient needs right now regardless of their DNR status.

Up Vote Up Vote ×
Specializes in Geriatrics, Home Health.

Apparently, Dad wasn't a "strict DNR", whatever that means. Since I wasn't there, I got a lot of information secondhand from my sisters, who are both lawyers.

Up Vote Up Vote ×
Specializes in Geriatrics, retirement, home care..

I've seen this way too many times... I had a family member (POA) for one of the residents at our facility come in and ask the doctor to D/C all meds for the resident because the resident was very weak one day so he was convinced she was going to pass away. family kept arguing that they signed a DNR for the resident and they did not want them on meds any more because they were "unnecessary". Thank god the doctor didn't listen to the family.

Up Vote Up Vote ×
Specializes in Hospice / Ambulatory Clinic.

It could be worse. I've had a string of patients lately on hospice continious care who are full codes. The admission nurse keeps on dropping the ball because she doesn't want to bring it up. But seriously these are pt's that are going to die sooner or later. It makes no sense to do full palliative care to keep the patient comfort to having to jump their bones when they stop breathing.

On the POLST has a section to transport to a facility if the patients comfort needs can't be met at home does it not?

Up Vote Up Vote ×

I agree with you it is very sad, what if the patient is in pain? they shouldn't have to suffer this and monitoring would indicate this might be happening. Where's the dignity and respect?

Kkestral

Up Vote Up Vote ×
Specializes in Gerontology, Med surg, Home Health.
I've seen this way too many times... I had a family member (POA) for one of the residents at our facility come in and ask the doctor to D/C all meds for the resident because the resident was very weak one day so he was convinced she was going to pass away. family kept arguing that they signed a DNR for the resident and they did not want them on meds any more because they were "unnecessary". Thank god the doctor didn't listen to the family.

95% of the medication people take in LTC could be considered unnecessary.

Up Vote Up Vote ×

TothepointeLVN, I always wondered why some inpatient hospices require ACLS certification. I thought, "ACLS... for hospice?!?" But apparently a DNR is not required for admission into the inpatient hospice programs.

Up Vote Up Vote ×
Specializes in Hospice / Ambulatory Clinic.

I always thought hospice + DNR went hand in hand but this company I've been staffing for lately seems to be very lax on getting them signed. Partially because they have the admissions done by very young RN's with very little training or experience ( one would be fine without the other but together.... ) I've been there when one of them was doing to admit and they basically worded it as would you like your dad to be DNR or to do everything. Well to an uneducated family "everything" sounds better doesn't it? Luckily the nurse that relieved me had a POLST and we got it signed.

The nurse mentioned above got royally (insert bad word) when he went to a case with NO paperwork present. Pt passed with the girlfriend saying it was ok. They had no $ for a funeral so the Coroner came to pick the body up. Well the coroner chewed him out about not calling 911 and chased him to his car saying they would sue. He was like what part of hospice do you not understand? He wont staff a case without a DNR now and I don't blame him.

Respite care is part of the hospice service so I can understand (maybe) not having a DNR but gosh people die when your not expecting them to all the time. Also there is too much overlap between home health companies starting hospice divisions and transferring pts to hospice to get paid for a higher level of care. I hate it when the on call nurse doesn't exclusively do hospice. They really dont "get" hospice y'know

Up Vote Up Vote ×
95% of the medication people take in LTC could be considered unnecessary.

What are they on? Antihypertensives, oral antidiabetics or insulin, flomax, digoxin, coumadin and/or aspirin, synthroid, vitamin D, iron, phos-lo, antidepressants, alphagan, statins, allopurinol, sildenafil (pulmonary htn, not viagra hehe)

Not sure which ones are unnecessary. I mean, if a resident had a strong desire to take less medication or if someone was actively dying, I could find ones to do without. But otherwise.. ??

Up Vote Up Vote ×
Specializes in Gerontology, Med surg, Home Health.

If someone is going to die in a week or a few days, they don't need vitamins, statins, alphgan, allopurinol,iron,flomax, and probably the antihypertensive.

Up Vote Up Vote ×

Perhaps. But you said long term care, right? I may be wrong but I didn't think that meant everyone is dying in a few days.

Up Vote Up Vote ×
Specializes in Gerontology, Med surg, Home Health.

I said IF SOMEONE IS GOING TO DIE IN A WEEK OR A FEW DAYS. Of course not everyone in long term care dies in a few days. It's very easy for some people on here to criticize by taking a sentence or two out of context. And, I still say that many many of the people in long term care (and in general for that matter) take way too many meds. A 96 year old woman does not need hormone replacements, vitamins, and statins.

Up Vote Up Vote ×
+ Add a Comment