Well, what I've long suspected about the hospital in the town where I work is, in fact, true: DNR indeed does mean "Do Not Treat". The EMTs won't even transport someone to the ER if their advanced directive says "comfort measures only", even if they're in obvious DIScomfort. Why? Because some group of high-ranking muckety-mucks has decided that treating the sick is not a 'cost-effective' use of the hospital's services.:angryfire
I couldn't believe it when I read about this in the newspaper. Then I actually heard about it again from the paramedics I called today for a resident who was having severe back pain from an unknown cause. They were very sympathetic, but they told me the order had come down NOT to transport anyone to the ER unless they were, essentially, a full code and had one foot already in the grave. In other words, if a patient is elderly and/or has a DNR order, the hospital won't even 'treat 'em and street 'em' anymore. They won't even LOOK at them.
I am so angry right now I could spit nails. Naturally, I don't believe in using the ER as a primary care provider, but for crying out loud, when one of my residents is desperately ill or in pain and I don't know why---and their PCP isn't responsive to their needs---where else are we supposed to turn for help? And God help you if you're over 65 and on Medicaid.......you can't use the ER, but you also won't be able to find a PCP willing to take you anymore.
The thing that really burns me up is the fact that our Greatest Generation paid into the "system" literally for DECADES, and now when they need help, it's not there for them. In fact, the healthcare conglomerate here in our area treats them like parasites. Unfortunately, the organization is a monopoly, so it's the only game in town. And now it's turned every standard of decency I can think of on its ear: you're welcome to use the ER if you have private insurance and/or are young and 'productive', but if you're elderly, frail, and/or poor, the hell with you.
Yep, this really makes me look forward to old age..........when my body starts failing, I think I'll just walk way, way out into the wilderness and let nature do what it will, as our ancestors used to do when they sensed that their time was near. It beats the heck out of begging for some small share of mercy and being treated like a "useless eater", as one Adolf Hitler used to put it.:angryfire
The patient in question may be 97, but until a couple of days ago she was no more in the active process of dying than you or me. She has been healthy as a horse her entire life---alert, pleasant, ambulatory, a mite forgetful but otherwise cognizant, no multisystem organ failure, only the occasional bout of angina for which she takes NTG. She just happens to have signed a POLST (Physician's Orders for Life Sustaining Treatment, a short form of the advanced directive) some years ago that states that she wants comfort measures only IF SHE IS DYING.
Earlier post mentions wonder how Joint Commission would feel. Well, just to be helpful--If you have concerns aout patient care, that you feel are not resolved please contact the joint Commission office of Quality Monitoring at 630-792-5636. Just another avenue to try to right a few wrongs. :typing
Patient advocate is a tough role but one we are mandated to perform as nurses. Go up the proper chain, don't allow yourself to be shushed, everyone has someone or some enity that they have to report too.
Pain control is a huge issue. If it is not met by the PCP, change or go up. If that means ER trip, it is justified. DNR definition is not defined nationwide , it is local in most cases. Our hospital has gone through many definitions over the last few years. Soon to reach those "golden years" only to find they are more bronze than gold and tarnished around the edges.:icon_roll
Specializes in LTC, assisted living, med-surg, psych.
Well said, Gwennie Lee, and thank you.
I finally have some good news to report on this resident. After three weeks of her being in constant pain (even with Tylenol#3), deteriorating mentation, constipation from the pain pills, and needing to be assisted with almost everything, I have at last been able to get someone at her doctor's office to LISTEN. It wasn't her own PCP, but no matter, he was willing to see her just as soon as her daughter could get her in there. Now we have better pain meds, stool softeners, physical therapy orders, and a new doctor who actually looks beyond the patient's insistence that she's "fine" and realizes that she is definitely NOT fine. Thank God!!
A few days before my father died, a nurse told me that he had MRSA a while ago and that once that gets into you blood stream it can cause tha symptoms he had - agitation, confusion, disorientation. I was told that he would not let them take off his foot (I saw the wounds and they were awful and both of his feet had a really bad odor that I couldn't get out of my nose for a while). Do you think some of his problems were caused by MRSA? He was on 8 hr Morphine for a while, because he told me he was a few wks before he suddenly went down. He was 90 yrs old, with diabetes, heart trouble, really bad statis ulcers on both feet, gloucoma (douldn't see very well) and getting hard of hearing. He told my daughter that he just couldn't stand going blind. At the end they gave him instant acting morphine and the 8 hr dose too. What do you think about the MRSA? I know that a lot of pain meds can cause confusion and disorientation, but I just wanted to know what anybody thought about the MRSA. Sorry to talk so much, had to ask this.
Specializes in LTC, CPR instructor, First aid instructor..
Well, what I've long suspected about the hospital in the town where I work is, in fact, true: DNR indeed does mean "Do Not Treat". The EMTs won't even transport someone to the ER if their advanced directive says "comfort measures only", even if they're in obvious DIScomfort. Why? Because some group of high-ranking muckety-mucks has decided that treating the sick is not a 'cost-effective' use of the hospital's services.:angryfire
I couldn't believe it when I read about this in the newspaper. Then I actually heard about it again from the paramedics I called today for a resident who was having severe back pain from an unknown cause. They were very sympathetic, but they told me the order had come down NOT to transport anyone to the ER unless they were, essentially, a full code and had one foot already in the grave. In other words, if a patient is elderly and/or has a DNR order, the hospital won't even 'treat 'em and street 'em' anymore. They won't even LOOK at them.
I am so angry right now I could spit nails. Naturally, I don't believe in using the ER as a primary care provider, but for crying out loud, when one of my residents is desperately ill or in pain and I don't know why---and their PCP isn't responsive to their needs---where else are we supposed to turn for help? And God help you if you're over 65 and on Medicaid.......you can't use the ER, but you also won't be able to find a PCP willing to take you anymore.
The thing that really burns me up is the fact that our Greatest Generation paid into the "system" literally for DECADES, and now when they need help, it's not there for them. In fact, the healthcare conglomerate here in our area treats them like parasites. Unfortunately, the organization is a monopoly, so it's the only game in town. And now it's turned every standard of decency I can think of on its ear: you're welcome to use the ER if you have private insurance and/or are young and 'productive', but if you're elderly, frail, and/or poor, the hell with you.
Yep, this really makes me look forward to old age..........when my body starts failing, I think I'll just walk way, way out into the wilderness and let nature do what it will, as our ancestors used to do when they sensed that their time was near. It beats the heck out of begging for some small share of mercy and being treated like a "useless eater", as one Adolf Hitler used to put it.:angryfire
You have no idea how much I agree with you. Thankfully, I now have a physician who believes me. I got rid of the fester. But get a load of this. My secondary insurance has denied purchase of a back brace I need. If my doctor didn't think I needed it, I'm sure he wouldn't have ordered it. Maybe I should pack up my used disposable briefs and send them to the person who makes these decisions. Maybe then he,she, or it will get the message.:madface:Yes, I'm talking about Medicaid cutbacks.
DNR is a difficult subject sometimes. During our recent flu epidemic. my hospital unit was filled to capacity with seriously ill patients. The staff was stretched to the max [and beyond] and resources were starting to run out. In the mist of this time, we had to make a choice between two very sick patients. One was a 30 y.o. immigrant with no significant medical history; the other was a 90 y.o. with seven co-morbid conditions and a DNR. The doctors and administration chose to accept the younger patient because he had the greatest chance for a meaningful recovery. Was it the right choice? I don't know. If I werethe one facing the task of making the decision, I probably would have done the same thing. Like it or not, hospital resources are finite.
Specializes in Onco, palliative care, PCU, HH, hospice.
It's so repulsive to me how elderly people fall through the cracks. I bet whichever administrator wrote this "Do not treat" policy's dear old granny was sick and was a DNR he'd make sure the ER saw her.
Cudos to the OP, I agree with you 100% and admire the fact you're fighting for what's right!
Naturally, I don't believe in using the ER as a primary care provider, but for crying out loud, when one of my residents is desperately ill or in pain and I don't know why---and their PCP isn't responsive to their needs---where else are we supposed to turn for help? And God help you if you're over 65 and on Medicaid.......you can't use the ER, but you also won't be able to find a PCP willing to take you anymore. 
Go up the proper chain, don't allow yourself to be shushed, everyone has someone or some enity that they have to report too. 
SuesquatchRN, BSN, RN
10,263 Posts
I was simply pointing out that the term was coined by a notorious murderous maniac. Yes, others have used it since.