dnrs in icu

[RN1980]

tell me why medicaid/medicare is going to pay an high icu charge for a 88yr stroked out full for the last 5yrs nursing home patient that was admitted for dehydration and pneumonia...clearly not an admission that requires icu attention and charge. got a new doc and he has to have all his dnrs up here, besides there is nothing that we are going to do to him that can't be done at a lower level of care. medicaid/medicare fraud/waste and abuse i tell you..

[suanna]

Just a little story:

My mother was a DNR for her last 4 or 5 admissions to the hospital. End stage COPD, S/P CVA, Hip Fx, largely bed-fast--up to chair with asst of 2. None the less when she was admitted we wanted everything done short of intubation/cpr because

that is what mom wanted. She was at times a bit confused but generaly oriented and cooperative with care. The point is, with all her medical problems she often required more care than could be provided on a gen med floor. Q2 resp Tx., IV lasix, electrolyte replacement, glucose monitoring, ectopy management (SVT, PACs, blocks.) As a result of aggressive management she got to see her last son married and one more grandchild born. We were thankful for every day we had with her but if her "time came" we were OK letting her go. She didn't want to live on the vent with trach/peg. Statisticaly speeking survival to discharge is very poor even with well managed codes. You may get a pulse back for a while but if the body is willing to "code" odds are the patient isn't going to get out of the hospital alive.

Code status is no indicator of the need for ICU management. Sometimes all we are doing is keeping the person alive with a lot of care to give the family time to accept the inevitable. This is a worthwhile goal.