I work in an ICU setting at a large teaching hospital (1000+ beds). Lately there has been this mindset among the docs regarding how far we should go when a pt with an in-hospital "do no resuscitate" order is going down the tubes.
Our DNR form is basically divided into two sections: "full DNR" says something along the lines that "in the event of cardio/pulmonary arrest no measures should be taken, including intubation, vasoactive meds, shock, cpr, etc". Then there is "modified DNR", in which the pt/family/doctor picks out which treatments we can/cannot do. I imagine this is pretty standard, based on the several hospitals in which I've worked.
So here is an example. Had this full DNR pt who was already intubated prior to the DNR order, whose BP was crashing. Doc wanted to start her on vasopressors. We jumped up and said no way, the pt is full DNR, all we can do is give fluid. The doc said technically since the pt hasn't "arrested" that we can do whatever.
This did not make any sense to us, so we called our legal department in the middle of the night to get more info. Legal said that the doc is correct and that we should do whatever to save the pt's life!! Our unit manager was made aware of this too, and she said the same thing. We were totally shocked!!
In my opinion, starting vasoactives based on this situation is unethical, and our pre-printed DNR order sheet is rather unclear. Even though the pt hasn't lost her pulse, myself and all the other nurses in my unit agree that this is a heroic measure that either the pt or the next of kin doesn't want.
I mean how far can one take this? If there was a full DNR order on a pt who wasn't intubated already, and suddenly went into resp distress (but not apnea),... would they want us to intubate?? In the minds of these docs, she "technically" hasnt coded yet. It's crazy!!!
If my family member was DNR, and I came in the next morning to find that they were intubated, shocked, and on drips, I'd be infuriated! I could also picture some people taking legal action as well.
Any feedback from you guys? Anyone else have a similar issue at their hospital?
