I can't believe the MD did that

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Specializes in Hospice.

I work on a Progressive Care Unit and recently we had a cardiologist perform a cardioversion on an 80 y/o man who is a DNR. The patient came in with NSTEMI, and due to his age and other diagnosis of Cancer (I wasn't his nurse so I am not sure where primary source is but has mets to brain) a heart cath was declined by family.

The patient went into atrial fibrillation, but rate was controlled with a beta-blocker, the cardiologist on day 3 decided to do a cardioversion and family agreed. The nurse taking care of him told me that when she asked the doc what sedation he wanted so she could send to pharmacy for the drug, the doctor said that the patient didn't need any because the nurse had just given the patient Dilaudid 1mg IV a half an hour prior and he was concerned with giving the patient anything else. The cardioversion was performed successfully at 50j and the nurse said that the pt moaned prior, during, and after the procedure.

I am appalled that the doctor performed this procedure, because the patient was due to be evaluated by a LTC facility the next day and, the plan of care was for hospice at the LTC facility. I am completely irate that only Dilaudid was used to perform the procedure. And, finally, I am upset that the nurse wasn't being an advocate for the patient whether he could speak or not, especially since he couldn't communicate!

So, anyway, my question is...am I the only one who thinks this is wrong on all levels?

Just a side note, the pt went back into a-fib that night.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

It is wrong. Dilaudid, while could diminish the sensation of pain, has no amnestic property (the ability of a drug to make the patient not remember the painful treatment). I would have advocated for Versed.

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Specializes in Hospice.

Me too, and if the doctor thought the patient would not do well on versed then the procedure should not have been carried through.

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I also would have advocated for the versed. And unfortunetely, someone did not educate the family (who were the decision makers) about this procedure well enough. If the patient was rate controlled on meds, not sure why the cardioversion idea even came up to begin with.

Does your parent company have an ethics hotline? I would use it.

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Specializes in Hospice.
I also would have advocated for the versed. And unfortunetely, someone did not educate the family (who were the decision makers) about this procedure well enough. If the patient was rate controlled on meds, not sure why the cardioversion idea even came up to begin with.

Does your parent company have an ethics hotline? I would use it.

I didn't think of that, thank you.

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The sedation issues aside - the entire thing seems inappropriate given the overall plan of care. I just keep thinking $$$$.

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Specializes in Critical Care, Education.

Report to the Ethics Committee. They should be addressing futile care issues.

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Specializes in Emergency, Telemetry, Transplant.

I'm not sure it was wrong to do the cardioversion...a DNR does not necessarily preclude such a procedure.

However, to do it with no sedation is totally unacceptable.

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DNR comes in many forms these days. I 've had patients that were DNR's but we did everything except the cardiac meds. He should have been sedated though.

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Specializes in Hospice.
I'm not sure it was wrong to do the cardioversion...a DNR does not necessarily preclude such a procedure.

However, to do it with no sedation is totally unacceptable.

I agree that a DNR does not mean "do nothing", but the plan was to discharge to a LTC with hospice. He was not symptomatic with the atrial fibrillation and his rate was controlled.

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Specializes in Hospice.
Report to the Ethics Committee. They should be addressing futile care issues.

Jadelpn also posted the same comment, thank you for the advise. I plan to do this right away.

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Jadelpn also posted the same comment, thank you for the advise. I plan to do this right away.

Please do let us know what happens. It may take awhile for it all to shake out, but keep pressing.

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