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Is This Assault?

Nurses   (6,939 Views 12 Comments)
by Haunted Haunted (Member)

Haunted specializes in Most of it.

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Just wanted to know if anyone has had this experience: Patient admitted to the hospital for infection, has advance directive in chart stating DNR id found uncounsious, my condition will not improve, etc. Standard no code directive. Patient found in bed cyanotic, pulseless, non responsive and CPR initiated, compression and defib. Patient then found to have pulse, ST, intubated and transferred to ICU on ventilator. Sedated with propofol and ativan for mild seizure activity, neuro consult results are very grim, prognosis poor.

Now, family had been requesting that patient be removed from life support, which eventually happened, comfort measures given and patient expired about 48 hours after. Wouldn't the hospital or somebody be at fault given the patients code status and if so, would it be considered assault? I know if a patient refuses a medication or treatment and I do it anyway that can be considered assault. Or I could be wrong. Really sad story and wondered how common this happened. Thanks all, I've missed the board but has some problems with my password.

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1 Article; 32,400 Visitors; 5,758 Posts

Is it possible that this institution has a poor plan in place for identifying person who have DNR order? I have seen situations like this and it usually means that someone who not familiar with pt. comes across them in this condition and calls the code. I have wondered myself if you are liable for starting CPR when none is wanted. The rules most likel vary from state to state.

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57,413 Visitors; 10,263 Posts

DNR's don't mean squat.

Here in NY, if we ship out a resident from our LTC to a hospital, they must have a NEW DNR initiated for the hospital. Each and every time.

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3,021 Visitors; 97 Posts

Unfortunately, this does happen, to both inpts and otpts. Here, in WI, we have both a means of immediately determining whether a pt (in or outpt) prefers dnr status. In the 'heat of the moment', more than one caregiver has made a hasting act toward intervening and overlooking the appropriate bracelet on a pt's wrist. Yes, it is battery (assaut is the threat, battery is the action).

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lsyorke specializes in Med-Surg, Wound Care.

6,793 Visitors; 710 Posts

Having just gone through a hellacious battle with a doc over a families members dying wishes, yes this is assault.

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Haunted specializes in Most of it.

8,344 Visitors; 522 Posts

Having just gone through a hellacious battle with a doc over a families members dying wishes, yes this is assault.

Can you add some details regarding that incident? I'm fuzzy over the assault vs battery. This patient had an advance directive on file that followed her throughout each admission and yet no code status was noted in the last admit note by the MD, who had been her doc for 10 years , nor was it on any Kardex. None of the staff were aware that she was a "no code" and she was unable to inform them. It was a horrible situation, one that no one should have to endure.

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ERRNTraveler specializes in Peds, ER/Trauma.

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The only way it would NOT be assault or battery is if it were not immediately clear at the time the pt. was found unresponsive what their code status was. If a pt's code status is unknown, CPR/ACLS must be initiated. If, however, the pt's code status was know (they had a DNR bracelet on, or there was a DNR form posted at the bedside), and hospital staff disregarded the posted DNR status and started CPR/ACLS anyways, then yes, it is assault/battery.

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7,460 Visitors; 672 Posts

Awhile back, I wrote a litle card with all my pts room numbers on it and put little notes by each - code status and any other pertinent info (blood hanging, etc.) and gave it to another RN while I went to dinner. My charge nurse walked into one of my rooms while I was gone and found that my pt had passed away (I had checked on her about 15 minutes before and she was okay, but I was expecting her to go at any time). Instead of looking at the pt's wrist to see if she had a DNR band on (which she DID), she ran out of the room and yelled down to one of the other RNs "Is room XYZ a full code??" That RN didn't know, so they ran and looked at the chart and saw the DNR sticker on the front of it, so they called the chaplain instead of calling a code. When I came back, I was very annoyed because I had told the person who was watching my pts that this pt was a DNR and it was written on the card which that RN had left at the station, AND the pt was wearing a DNR band, and the charge nurse (and this is my ANM we are talking about) is supposed to have that written on the census. Yikes! In this case, it was pretty clear that she was a DNR, but if at any time they are unsure of code status, they will attempt to resuscitate. I don't think it would be battery unless they personel knew that the person was a no-code and they did it anyway.

I have also heard of cases where the family insisted that the pt be coded despite the DNR, and I have never heard of anything where the HCPs said, "nope, sorry, that's her wishes!". I don't know what you would do in that situation...I mean if that would be considered battery or not. It's against the pt's wishes, but if they pt is unable to make decisions...

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lsyorke specializes in Med-Surg, Wound Care.

6,793 Visitors; 710 Posts

Can you add some details regarding that incident? I'm fuzzy over the assault vs battery. This patient had an advance directive on file that followed her throughout each admission and yet no code status was noted in the last admit note by the MD, who had been her doc for 10 years , nor was it on any Kardex. None of the staff were aware that she was a "no code" and she was unable to inform them. It was a horrible situation, one that no one should have to endure.

This situation was with my father. There was a DNR on the chart, no advanced directive on this admission(they forgot it), but was on the chart for previous recent admissions, but I was Health Care Proxy,which was on the chart. Dad was in a hospital 2 hours from me. I was notified that he was going downhill fast, so I went to the hospital. He was obviously dying. Third spacing all fluids, resp rate 48 with 100% O2. Confused, C-diff, Urosepsis, COPD, CHF, and I'm suctioning him every hour. I placed a call to his doc three times, with no return call. My Dad's nurse was very happy to see me. Even though the doc was well aware of my Dad's wishes he continued to order abg's...hmm, we're not intubating....CT of abdomen....not a surgical candidate if anything is wrong...EKG's...nothing showing on the last three.

When the doc called the nurse station he wanted an NGT dropped for PO vanco. Luckily his nurse(who was awesome) came and got me. I told him that the NGT was not happening. I was carrying out my Dad's wishes, that we had spoken about ALOT over the years. He was adamant that the tube be dropped. I finally had with him and explained that if he wasn't comfortable with end of life decisions, then he should transfer my Dad's care to another doctor. His parting shot was "make sure the health care proxy is on the chart".

He then showed up at the hospital an hour later to argue more. I stood my ground and he finally walked away. Dad passed away about 8 hours later, quietly, no tubes, and with some dignity.

IF I hadn't been there he never would have called me, even though I was the health care proxy of record. He would have put in an NGT.

I have to give a huge debt of gratitude to my Dad's nurses. They were so supportive of me and my Dad. Made me proud of my profession.

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57,413 Visitors; 10,263 Posts

I'm fuzzy over the assault vs battery.

Very simple. Assault is verbal, battery is physical.

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lsyorke specializes in Med-Surg, Wound Care.

6,793 Visitors; 710 Posts

Very simple. Assault is verbal, battery is physical.

Assault/Battery

In most states, an assault/battery is committed when one person 1) tries to or does physically strike another, or 2) acts in a threatening manner to put another in fear of immediate harm. Many states declare that a more serious or "aggravated" assault/battery occurs when one 1) tries to or does cause severe injury to another, or 2) causes injury through use of a deadly weapon. Historically, laws treated the threat of physical injury as "assault", and the completed act of physical contact or offensive touching as "battery," but many states no longer differentiate between the two

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Haunted specializes in Most of it.

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To the poster who replied the story about the Dad, how lucky he was to have you! This has been a horrible trauma for my entire family. Mom had to endure being intubated, drooling, gagging and vomiting, not to mention having gone to so much effort with my Dad and attorney to draw up these documents so she would never have to go thru this. I will never get the image of her out of my mind, nor the look on my Dad's face, or the sight of all the tears shed at the site of this beautiful woman placed in such an undignified position. When we were finally able to get the order to extubate and move her to the med floor with comfort measures only, IV fluid, MS drip only the kindness of the receiving nurse (Thank you Barbara at Eisonhower 3rd floor!!!!) was such an inspiration. Her kindness towards these terrified kids, 6 grandkids who dropped everything to be there, to hug her and say goodby, also made me so proud of this profession and the people who are in it. It wasn't anything she did from a clinical standpoint, it was her instinctive sensitivity, grabbing extra chairs, water, soft drinks, a hug if needed. I did speak with the nusring supervisor today to convey how much the nursing staff helped my family throughout this ordeal but am left wondering, with such a specific advance directive in place, how could such a thing have happened and also note that I was always aware of code status for all my patients. Well, Mom is in a better place and if any of your friends or family pass her way, they will enjoy her as we all did. There seems to be this empty spot in my heart right now. Thanks for the advice.

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