DNR

[thisnurse123]

This has probably been asked before.

Fake scenario:

Patient has frequent UTI’s and starts to wheeze. Has been hospitalized for a similar incident one month prior. The provider RN on call says to send them out. The POA refused. The patient was sent out anyway. Is this usual?

[offlabel]

Usual for a POA refusal or sending a patient under DNR to the hospital? DNR is not hospice care. A DNR does not remove the duty to treat. If the conversation about comfort care/hospice needs to be had, it needs to be before the patient has an acute medical problem needing treatment. 

[thisnurse123]

Thanks that’s what I figured. DNR doesn’t mean do not treat?

[JKL33]

Curious--what was the rationale for not carrying out the POA's directive?

[thisnurse123]

Nurse practitioner stated they are a full code. So NP determined this is an acute situation. Requested mucinex for patient and emts didn’t want to transport but did.

[chare]

If the patient is competent, he or she can refuse any offered treatments.  If he or she isn't competent, her or his POA can refuse as well.  The fact that the patient is presenting with an "acute situation" doesn't affect this.

[thisnurse123]

Interesting I guess the best way to go about it then is to contact the provider, see what they think then if they determine to send them to the hospital call the POA after they are sent to the hospital. Because a lawyer stated it’s OK in an acute situation to send out since a DNR doesn’t mean do not treat and it can be seen as neglect to delay care?

[thisnurse123]

But also the family should just ask for orders to not hospitalize. In this situation it seems something fishy was going on.

[chare]

1 hour ago, thisnurse123 said:

... Because a lawyer stated it’s OK in an acute situation to send out since a DNR doesn’t mean do not treat and it can be seen as neglect to delay care

How and when did the lawyer become involved?

1 hour ago, thisnurse123 said:

But also the family should just ask for orders to not hospitalize. In this situation it seems something fishy was going on.

Not necessary.  The POA was contacted and said the he or she did not want the patient sent out.  And what do you see here as fishy?

[thisnurse123]

Good to know for future. Never had this happen before.

[Lunah, MSN, RN]

2 hours ago, thisnurse123 said:

Good to know for future. Never had this happen before.

Never had this fake scenario before? ?

[offlabel]

Well, without knowing what exactly the POA document itself allows or stipulates, its a moot discussion. POA doesn't give carte blanche authority unless it does...That being on a case by case basis...making assumptions on what a legal document actually says is a set up.