RRT on Patient for Hospice

[Crocsing]

Hi I graduated 7 years ago. I have no previous acute care experience and I am currently on a medsurg-tele floor. I am an insecure nurse. I tend to feel like I am incompetent or mentally unfit for the job. I have a dilemma and would want to ask from you guys who are more experienced than I am.

My co-worker had a patient to be discharged to home with hospice and suddenly became unarousable. She only withdraws to pain stimuli. She presented the same type of symptoms that made her family brought her to hospital in the first place. In this type of situation, is calling for RRT consult still warranted or needed?

[Herecomesthesun]

If the patient was a DNR I certainly would not call an RRT, but if the patient was having difficulty breathing it may be appropriate to call the Respiratory Therapist, then the Dr if needed... Make surr they are pulled up in bed and put the HOB up.

These things will help the patient, and help the family feel as if there family member is being cared for. Also keep calm, and educate the family on what is normal and expected.

*I work in an acute hospital now, but prior to that I spent 5 years as a hospice nurse.

[FurBabyMom, MSN, RN]

I don't feel like we know enough about the situation to make a decision on right or wrong. Others have pointed out that hospice does not always equal (nor does it require) a DNR/DNI order.

My grandmother was a "hospice patient" for more than a year before passing away from her disease process (type of cancer). She was admitted to a community hospital where we lived at the time, during cold/flu season that year following an ED visit when we thought she had pneumonia. My grandmother was not a DNR/DNI at the time of that visit, merely, she was not pursuing aggressive chemotherapy and/or radiation for her primary disease process, the cancer but very much wanted treated for "fixable" and "non-cancer" things. My grandmother was only a DNR/DNI the last two weeks of her life, and spent much of that time at an inpatient (but not hospital) hospice facility.

We had a section of the unit I used to work on that had previously been ICU, and was laid out more secluded than the rest of our unit. Big spacious, private rooms (much of the rest of our unit was double rooms). We got a lot of terminal extubations, withdrawal of cares, horrible prognosis situations admitted to those rooms. Many of those, I would not have called a rapid response call on. Call for more orders to achieve a less labored and more comfortable patient? Sure, although our comfort care order set in the presence of a DNR/DNI were very liberal.