Pt rights to go to the hospital

[mittels]

I just dont get it! I work in an assisted living facility as a HSD-RN.

We have many residents on hospice. There is one resident who is having terminal agitation mixed with periods alertness to the point of being totally oriented. I know that she has signed a DNR on Monday when she joined hospice and she has since had a significant decline over the past week. Prior to admission to hospice on Saturday this last weekend she was taken to the hospital and had to be coded. At that point is when she joined hospice when she came back to the ALF. She stated during one of her alerted states "I just dont feel right, I feel like I am sinking, I want to go to the hospital, take me to the hospital now." I called S.S. and the on call nurse told them of her rapid decline and terminal agitation and of her statement that she demanded to go to the hopital. Her daughter and son were present at the time by the way. I do know that when I worked for hospice for 2 years that if a pt demanded to go even with a DNR we needed to follow through. Well the nurse - on call came out and the SS worker came. Her wishes were not followed through by the nurse with a simple call to the Dr. Nope she just gives an order for ativan and morphine. I dont get it!!!!!!!!!!! Any one with any thoughts?

[Dave ARNP]

She's old and she's dieing. As a NP who see's all sorts of patients at the LTC (Hospice patients included), if one my residents request to the hospital, The Palms Casino, or even Mars... I'll do my durn best to make it happen.

Granted, I won't say that the MS and Ativan was a BAD idea, but if this little lady wanted to go to the hospital, she shoulda durn well been on her way.

Dave

[fab4fan]

Her hospice benefit should have been revoked (if she was wanting aggressive tx) and she should have gone to the hosp.

Pts. on hospice don't waive their right to tx. If it's outside the plan of care, you just revoke them; regular Medicare takes over. She can always be reinstated on the hospice benefit at a later date. No way would I have done what that on-call nurse did.

[aimeee, BSN, RN]

If the patient truly wished to go to the hospital then she can revoke her hospice benefit and go.

Were you present during the examination of the patient by the on-call nurse? Did she perhaps speak with the patient and offer her relief from her symptoms and her panic with some medication and perhaps did the patient agree to try that before being transported? It is not usual for patients to demand to go to the hospital, not remembering that the reason they were referred to hospice in the first place is that their physician saw that there was nothing that aggressive measures could do to reverse their condition. Often some soothing words in combination with some pain relief and anti-anxiety medicine, and maybe a prayer, give the patient the relief they actually need. Maybe much more relief than another scary ambulance ride and waiting on a gurney in the ER?

[renerian, BSN, RN]

I agree if a client wants to revoke/let them go to the hospital. I would think if you do not you could be held liable if it did not occur.

renerian

[mittels]

Originally posted by aimeee

If the patient truly wished to go to the hospital then she can revoke her hospice benefit and go.

Were you present during the examination of the patient by the on-call nurse? Did she perhaps speak with the patient and offer her relief from her symptoms and her panic with some medication and perhaps did the patient agree to try that before being transported?

Unfortunately I was not present during her seeing the pt. I am asumming that her rights were ignored because I have seen this hospice nurse in action and have worked with her before.

[chris_at_lucas_RN, RN]

Of course she should have gone to the hospital!

A DNR is revocable by the patient. Period.

If a patient has any rights at all, particularly a dying patient, the right to being cared for in the best manner possible is at the top of the list.

If your ONLY reason for making your decision was to save your license and protect your facility from liability, you MUST honor the patient's verbal wishes.

Be sure and document. If possible, get another RN to witness and also document.

But the right thing to do is protect the patient. Period.

[chris_at_lucas_RN, RN]

.... now if Hospice wants to terminate her from their program, that's a whole 'nother thing.

[fab4fan]

There are very strict guidelines for discharging a pt from hospice. You have to tread very lightly on that one.

[chris_at_lucas_RN, RN]

The strict guidelines are, I believe, for Hospice to abide by.

No one can interfere with an individual's civil rights, one of which is "life."

Hospice needs to tread lightly because it is Hospice's obligation to honor a patient's desires. If it violates the patient's agreement with Hospice, then Hospice has the right to terminate the patient's participation in the program. But Hospice NEVER has the right to deny a patient care. EVER.

Failure to grant an individual a reasonable request, like medical care, could mean criminal charges for unlawful imprisonment. She has the right to go!

No different from restraining a lucid patient without an order (documenting need to prevent self harm).

I'm betting no doc would write an order REFUSING that a patient be granted appropriate medical care.....

[mittels]

Originally posted by fab4fan

There are very strict guidelines for discharging a pt from hospice. You have to tread very lightly on that one.

Apparently, the social worker talked with her yesterday about going to the hospital and getting comfort and tx or staying home yadah yadah. I spoke with her daughter today because the resident was pretty much comatose. Asked her if her mother wanted to go to the hopital and she told me no she did not. Said that once her mothers anxiety was under control she said she did not want to go. Im not sure about this one. I did however document every thing.

[VivaLasViejas, ASN, RN]

It still amazes me how so many medical professionals, who ought to know better, seem to believe that "do not resuscitate" means "do not TREAT". I used to see this attitude all the time in long-term care, especially among doctors and paramedics, and it just sent me into orbit!! If a patient wants to go to the hospital, he/she should go to the hospital. Period. Not that the MS and Ativan weren't appropriate in this case, but this patient should NOT have had to get some kind of "approval" before being transferred to the hospital. Phooey!!