Dnr

deletethisaccount · Mar 11, 2008

but we are talking poa here right not uncle larry's second cousins wifes first husbands grandmas bothers wife 3rd cousin 15 times removed....

that's right... the poa. however, i just called the national hospice and palliative care organization and was told differently. if the client has a dnr on file, the healthcare person it to follow the client's wishes (the dnr).

...i'm so confused...

aeauooo · Mar 11, 2008

I've never done CPR on a patient I knew had a DNR. I've pushed a crash cart towards a room only to stop in the hall when someone yelled, "He's DNR."

Legal next of kin can be a tough issue. A couple of years ago I had a patient who had a severe intracranial hemorrhage. Her ex-husband was on the unit insisting that we "do everything." Her 18 year old son drove from Idaho to Seattle, and since he was the LNOK, we withdrew shortly after he arrived.

Woodenpug, BSN · Mar 13, 2008

have had a patient whee as the fly member the md decided that pt was a dnr status, id not confer with pt or rest of family. pt was lucid but was terminal with another disorder
AN ABSOLUTE NIGHTMARE

I think I'm missing something here. That is an ideal DNR. The MD took responsibility because the MD knew resuscitation was futile. The only possible step missed was informing the family of the decision.

TiredMD · Mar 14, 2008

So... if the client has a DNR on record, and the family tells you to do CPR, you do CPR? I haven't read this anywhere... help me out, can you give me more info on this?

I don't know how this myth started, but let's be clear: A family member cannot legally invalidate a living will previously signed by the patient.

The problem that arises (and I think why people get confused about why we code people with living wills) is the wording of these documents. They will commonly say something along the lines of, "In the event that I develop a terminal condition . . ." or "If there is no hope of meaningful recovery . . . " These are very ambiguous statements, open to interpretation, and since you can't ask the patient for clarification, it usually comes down to the family talking to/arguing with the physician over what the patient "really" meant.

I see this one all the time: "Mom meant 'terminal' as in if she had cancer, not a situation like this!"

Or this one:

MD: "It is very unlikely your father will ever recover."

Family Member: "But there's a chance! If there's any hope of recovery, he wouldn't have wanted you to stop trying!"

So you can't really settle this on the spur of the moment. It takes time, long talks, discussions with the consultants. You can't do all this when the v-fib monitor is going off at midnight, and the Neurologist & Pulmonologist are at home sleeping. So we run the code, get them marginally stabilized, and schedule a family conference for the following day. A week later care gets withdrawn. Same outcome, with $50k dumped down the toilet.

aeauooo · Mar 14, 2008

MD: "It is very unlikely your father will ever recover."
Family Member: "But there's a chance! If there's any hope of recovery, he wouldn't have wanted you to stop trying!"

If I had a nickle...

TiredMD · Mar 15, 2008

If I had a nickle...

Amen, my brother.