Telemetry for DNRCC patients

[mar354, BSN]

I'm relatively new to working as an RN in the Medical ICU, and have had several patients transition to DNRCC (called "AND" in some areas) during my shift. Our hospital has a standard DNRCC order set which our MICU docs use when those patients are ready to transition, w/ individual modifications if necessary. The order set includes vitals every 24hrs, dc'ing all continuous monitoring including tele, pulse ox, hemodynamics, etc, and dc'ing all meds except those given for comfort. O2 is rarely ordered, usually only if it's used at home. Even if used, we don't typically titrate off sats--just titrate in a small range based on comfort, w/ PRN meds for SOB available too.

So, when I transition a patient to DNRCC, I detach their telemetry leads, pulse ox, and any extraneous equipment that can only impede comfort, turning off the monitor. If pt and/or family has a strong desire to keep the monitor on, I put it in "comfort care" mode, which displays vitals without warning alarms. However, CC mode still alarms for a lethal rhythm, which is another reason I prefer to take my folks off entirely--the order is dc'd, after all.

I've been surprised to find that most nurses I give these CC patients to in report seem surprised and displeased that I took the pt off the monitor. No one has really told me why that is, however. I understand that we may have a better picture of how close the pt is to passing w/ monitors on, but the purpose of comfort care is comfort--I'm personally fine w knowing we can get an extra full set of VS if desired. Our hospital doesn't require a tele strip of asystole as part of death declaration when the patient is a CC, and docs are happy to declare by physical exam.

So, long story short, am I missing anything here? Are there benefits to tele in these CC patients i'm unaware of? What does your unit do in these situations? Thanks!

[InnovativeRN, BSN, RN]

Personally, I agree with your decision. When I have a patient transition to comfort care, I always take them off the monitor unless the family objects. I have found that leaving the patient on the monitor leads families to obsess over the numbers and can be an added source of anxiety.