Is a do not send to hospital order valid? Is it valid in all situations? I had a DNRCC patient have a heart attack and was in a great deal of pain. He had a PRN order for nitro and it was given as directed with no relief. Followed directions that stated call dr. for further instructions with no relief from pain. Called dr. and advised as to situation, including DNRCC directive. He asked if the patient had orders for morphine, which the patient had no orders and was not a hospice patient. I also advised dr. that he could order the morphine, however in our rural setting the morphine would be difficult to obtain in a short period of time. It would take hours to get the needed pain medication. The doctor ordered the patient to go to the hospital to eval and treat for pain.
This is the 3rd shift and I am the only nurse. When the DON arrived in the morning, I was given the "what for" for sending this completely lucid patient to the hospital for pain management. The lucid patient was asking me for help and asking for something to make him feel better. I could not comply with anything other than Tylenol. The DON stated this patient has a do not send to the hospital order. I asked to see that order. It was nowhere to be found in the chart.
By the way, this patient came back from the hospital on round the clock morphine and ativan and on hospice. I am thinking this is exactly what I wanted to accomplish in the first place. How could I have handled this differently? What would you have done? My impression is that DNR CC specifically states that he is to get comfort care that I could not provide. Now I can provide this. Answers and advice please?!?!?!?!?! I will also be asking my DON for answers and advise. My impression was that I was to wait hours for the morphine, but I will assume nothing for the future.
