DNR POLST not signed by conservator, signed by MD

[Loving.Very.Nice]

I work at a Rehab SNF. We have this patient that was recently diagnosed with end stage cancer. The patient is conserved and was previously a full CODE ( or may still be one.)

My question is: Is the patient a full code if you have a signed DNR POLST by the doctor but no signature of the conservator? According to SSD notes, the conservator has been Faxed the POLST many times, voicemails have been left for the conservator and one SSD note states that the conservator needs to get a supervisor to sign the POLST.

If this patient codes what do I do? My DON has been telling the nurses that she is legally a DNR because we have a doctors order.

All meds for this patient's HTN and other conditions have been stopped and all we have to give is Roxanol. Should the meds have been stopped before we had a signed POLST?

I'm very concerned for my license.

[netglow, ASN, RN]

Hmmm. Your DON needs to revisit this. Show her missing signatures on the forms. It is my understanding that MD, POA, Witnesses must be on DNR form for validity. Do you guys have a socialworker to run this down? If a true social worker, they have other avenues to get info in a hurry. The laws in each state/county differ, but the guardian must be contacted for approval if POA for medical. It seems the guardian has responded once so h/she is reachable at some level. Never had your situation happen. Might page the MD and notify him of incomplete DNR.

I have worked hospice and I will not/cannot admit without the DNR form signed complete and secure, as well as an MD order to eval/admit for hospice. Once this has been done, then I can examine the patient, admit under my diagnosis, notify the MD and family of my findings and then work with the family/MD/nursing staff about the meds and tx.

[Loving.Very.Nice]

My problem is that SSD (Social Services department) does have a social worker and they have tried all week long to get the state appointed conservator to sign.

My other problem: is that my DON knows that the POLST is not signed and has put one nurse on suspension for questioning this patients CODE status.

[netglow, ASN, RN]

WOW. OK. Are you working today?

[Loving.Very.Nice]

I will go in in one hour.

[netglow, ASN, RN]

Ish, I'm trying to find any of my Hospice/LTC Allnurses go to's to see if they can help you with more ideas...

[leslie :-D]

there has to be a signature from the pt or it's poa/conservator and the physician.

the fact that the DON suspended a nurse, is concerning...but seemingly disputable (from the little that's been written.)

the bottom line is, if i am unsure, i will preserve life, versus let someone die.

Programs - Physicians Orders for Life-Sustaining Treatment Paradigm

leslie

[netglow, ASN, RN]

So glad that you were able to pop in and give some advice. :) I hope she can find a way through this.

[Blackcat99]

My problem is that SSD (Social Services department) does have a social worker and they have tried all week long to get the state appointed conservator to sign.

My other problem: is that my DON knows that the POLST is not signed and has put one nurse on suspension for questioning this patients CODE status.

It sounds like the nurse did the right thing by questioning this patient's code status. And then she got suspended for doing so? Unbelievable!

[springRN]

My advice is to check your facility's P&P on POLST. My understanding is that a POLST is a patient driven document. It is about the patient's or responsible party's choice and then in collaboration with the MD, he/she signs it.

Sounds like the SSD has tried to contact the conservator, too bad the conservator/supervisor signature is taking so long.

A nurse getting suspended just for questioning the patient's code status...something not right there!!

[netglow, ASN, RN]

She is in a spot isn't she. Here's sending her strength.

The more I ruminate for her, the more I code the pt. but as soon as I get to work I page the MD and let him know what's what. He probably figured all ducks were in a row, as it is not his deal to finish getting all the paperwork, IDK.

S/he MD was stupid to d/c ahead of the horse. But they will do that just to get it done in one swoop if they believe that someone else has secured the POA... (in this case no family to worry about/have long time consuming conversations with, in the MD's mind. If you crawl around for a while in an MD's pelt - Caddyshack reference). But in my experience, A decent MD will want to have had the conversation with the POA to cover h/her own ass and will document the conversation in notes.

Who knows what the law is if the guardian is not responding in a reasonable amount of time... what is considered reasonable?!

[txredheadnurse, BSN, RN]

Seems someone needs to go over the guardians' head to their supervisor and apprise them of the situation.