No rapid response for a DNR?

[AlphaPig]

This wasn't my patient, but last week on my med/surg floor a LOL who happened to be a DNR suddenly developed an irregular very fast heartrate and became less responsive. It was early in the shift, and because the patient's heart rate went from a baseline SR in the 70's to irregular in the 140's/150's, the nurse called a rapid response on the patient so an ICU nurse came over and evaluated, a stat 12 lead EKG was ordered,etc. Just standard. I was half paying attention to this while assessing my own patients just to see if the nurse needed any help with the rest of her assignment.

Anyway, when the attending physician arrived to do his rounds, he was *#$$&%. Stood at the nurse's station loudly complaining "Why was a RR called? She's a DNR!!" and was curt to the nurse and yelled to "just consult hospice" and "don't do anything" and told the ICU nurse to leave.

Now, to me, a DNR order is not akin to a "comfort measures only" order. I mean, if the lady coded we would not have tried to resuscitate, but she wasn't coding, only showing new cardiac symptoms.

The nurse was upset and thinking she did something wrong. I told her that she did the right thing for the patient.

What is your opinions? I know that there are a lot of details missing here, but just the general question of do you call a RR on a DNR patient?

[JB2007, ASN, RN]

DNR does not do not treat. The doctor was wrong and the nurse did tjeright thing.

[ChristineN, BSN, RN]

Interestingly enough, my grandma, who is a DNR but stable and not in hospice, was recently admitted to the hospital for a-fib with rvr. My family had difficulty at first with the hospital wanting to treat her as some of the healthcare providers wanted to act as if DNR equaled do not treat. Ultimately the decision of what to do should have depended on if the pt is indeed a hospice pt and what the family wants to do. With my family, even though grandma is a DNR we knew she would be stable once she got some Cardizem, which would not cause any pain or suffering for grandma.

[Sun0408, ASN, RN]

Agreed, the nurse did the right thing and the MD was wrong. I think education needs to be provided to "those" types of providers. DNR does NOT mean don not treat !!!

[tryingtohaveitall]

In the pediatric hospitals I've worked, there are different "levels" of DNR/AND and it's usually fairly well defined how aggressively we will treat. Some DNRs calling a RRT would be appropriate, others it wouldn't. Hard to say in this case with limited info.

[dandk1997RN, MSN, RN]

Very bad call on the MD's part. I received a DNR/DNI as a transfer from med surg the other day d/t hypotension (90s on 50s.). When I got her and assessed her, I realized her 60s on 40s and what appeared to be sick sinus syndrome, with rates bouncing from 28 to 90s, belonged on the unit, not intermediate cardiac tele where I had 4 other patients to watch. Called the hospitalist, got the intensivist to the floor, and did our own little rapid response without all the fuss. Her heart was still beating. She was still breathing. Not treating her would have been unethical. Just because she doesn't want CPR and a vent doesn't mean she doesn't want fluids, meds, and a PPM.

I really hope someone followed up with a nursing supervisor to speak with the MD about his misinterpretation, and I hope that pt got the tx she deserved.

[nursejami]

Definitely did the right thing. In one of my orientation classes at my hospital this topic came up and they said you would absolutely call the RRT! Like others above said, DNR is not "do not treat."

[Seas]

DNR comes into scenerio AFTER the patient dies. Previous posters explained this well.

Please you all, report this doctor.

[netglow, ASN, RN]

Explain it to that MD in the way of an example:

If a that patient was DNR but just fell and now has say, a LE compound fracture, and he refused to treat the patient simply because the patient was DNR, he would lose his license among other things, of course unless the patient refuses care.

[nrsang97, BSN, RN]

Agreed, the nurse did the right thing and the MD was wrong. I think education needs to be provided to "those" types of providers. DNR does NOT mean don not treat !!!

Exactly! I am a RRT nurse and would have suggested a cardizem drip or some other intervention.

The doctor was wrong.

[CapeCodMermaid, RN]

This is precisely the reason some states, mine included, are using the MOLST form....Medical Orders for Life Sustaining Treatment. The form goes everywhere the patient does and specifies ALL the treatments the person wants or doesn't fron CPR to intubation to C-PAP to dialysis to artificial hydration and artificial nutrition. A properly signed MOLST form is immediately actionable and is treated across all arenas as a valid MD order.

[lmccrn62, MSN, RN]

I ran a ERT team and we did respond to calls for DNRs. While no heroics just ensure we limit their suffering. Some staff and MDs disagreed I always encouraged the nurses to do the right thing.