Transfering DNR pts to MSICU

[Lorie P.]

:stonehere goes, we have this one md that will constantly send pts that are dnr's to the unit. he comes in makes rounds, sees the pt's bp is low, wants a dopumine drip, which we can't do on the med/surg floor then writes orders to transfer to the unit.

mind you these pts are usually 80+ with x medical problems, so he orders labs, blood, iv fluids, xrays, the whole nine yards. so then when we call the unit to give report and tell them pt's code is dnr we catch all kinds of hell.

no one ever says anything to this doc, the pts go to the unit and usually end up expiring there.

now last night he sent 4 dnr's to the unit and filled the last 4 beds, was talking to one of the unit nurses who was peed off cause 3 pts were kept in ed cause of no unit beds. 1 pt had k+ level 8.0 and inverted t waves, another was a cva with active cerebral bleeding and the 3rd was a young man that got stabbed in the heart with a knife during a fight.

just needed to vent! it makes no sence to me. yes, i understand what dnr means, but why can't we just keep this doc's pt clean, dry and comfortable?

any comments?

[TiredMD]

I used to work in an ICU in which the charge nurse interpretted "DNR" as 'withdraw care.' A doc would write a DNR order and this charge nurse would extubate the patient, shut off drips, d/c fluids, and let the patient die.

I think the law would consider this "murder".

The docs didn't notice? Pathetic.

Personally, my living will says, "Full code, extraordinary measures regardless of circumstances or cost" because I know all too well that:

DNR = 'oh good, we don't have to round on that patient'.

[aeauooo]

Are you kidding me??? People let her continue doing this?? Did the attending doc not realize this was happening? Did upper management not realize this was happening? Did the family not say something??

Tons of people have DNR orders written and then make a turn around and go home. That's crazy, unethical, out of the scope of practice, etc., etc.

I don't know how many events in my nursing career I look back on now and wish I had done something differently.

This was night shift, and I don't know what this charge nurse's relationship was with management or the physicians - who were rarely seen on the unit at night. We had short visiting times, so there were no visitors on the unit most of the night. Even though I got along with this nurse fairly well, our relationship was somewhat tense at times, so I realized that to survive I needed to pick my battles carefully.

I took a sign-on bonus at this hospital, which obligated me to work there for a year (or pay back the sign-on bonus). I terminated my employment there one year to the day after I was hired.

There are other things about that year that still haunt me.

[ilstu99]

My MIL was DNR - no intubation, no compressions (however that translates to everyone else's corner of the planet), and she was 86 years old when she passed. She was in a step-down unit, and received excellent care that allowed her to die with dignity, and for her family to spend valuable days with her, including allowing her grandson to return from Iraq to be at her bedside in her final days. I'm glad her facility has those policies.

I/we still expected her to be TREATED for her overall health while in the hospital, and that she would receive antibiotics, fluids, pain meds, etc. Her multiple chronic issues meant she was usually high acuity and required a lower ratio of RN:PT. She was a careful balance, and until her last 12 hours of life, she was still laughing and talking to our family and her long-time friends. About an hour before she lost consciousness she informed her nurse that he was "a hot number."

Anyway....not everyone who is DNR is hopeless or unable to be provided medical treatment....at least around here.

[BlearnRN]

I can see how that could be frustrating. We have pts that are full codes and basically should be dnr/dni on my floor. We have had to transport them to the ICU because of this. It is really sad to see people who are "knocking on the door"getting medications (not talking about pain meds/bp meds/etc) that you know that aren't going to help on top of getting poked and prodded. I had a hospice pt who was getting a different antibiotic every 8 hours ivp. I didn't understand what that was going to accomplish except to add more to the hospital bill. Were any of these pts on hospice?That is a big thing. Then they would not be transfered to ICU .

[sfn2008, RN]

On April 24th, 1990 my father was admitted to a Hospital in San Jose California, just one day after his 63rd birthday, due to worsening of his breathing status. Though he had suffered this chronic disease for years he had not required hospitalization since 1985 due to the excellent Respiratory teaching program provided by Kaiser.

This Kaiser affiliate is also a teaching hospital for Stanford Medical School. His regular physician, Dr. L.B., a respiratory specialist, turned him over to the care of the Resident Doctors.:zzzzz

J.M. spent 3 days in the Intensive Care Unit, was stabilized, and transferred to a Medical floor. Transfer orders were written by a Stanford Medical School doctor. In the long list of transfer medications she forgot to order Lasix, a medication that he had been taking for years. Without Lasix he didn't urinate in sufficient amounts.

Within days the nursing staff informed the resident MD of J.M.'s low urine output and not knowing that Lasix was missing from his orders, the doctor ordered IV fluids to improve output. His condition worsened as rapidly as the IV fluids were being administered.:uhoh21:

After a few more days his condition became so critical that Dr. L.B. ordered tests to determine if a possibly heretofore undetected cancer was the cause of his rapid deterioration. At this time she discussed CODE STATUS and No Code orders were written.

J.M. knew that he did not want to be put on a ventilator if the need arose. What he didn't know was that a NO CODE status would prohibit admission to the ICU in the event he spiked a fever.

Eventually the Lasix issue was addressed and on Friday May 18th plans were being made to transfer to a Rehab Center for follow-up care. The antibiotics that he had been taking since before he was admitted to the hospital had been discontinued when lab reports indicated no bacteria presence.

Late Friday night he spiked a temperature of 104.3 and was re-started on antibiotics and made as comfortable as can be expected for a man struggling for each breath that he took.

NO CODE patients were not admitted to the ICU in 1990. I held my father's hand as he struggled for his last breath just after midnight on Sunday May 20th 1990. I had been a practicing Registered Nurse since 1983 and had even worked as a staff nurse at this very hospital. I had done everything I could think of to get the NO CODE order off his chart. I took it to the ethics committee to no avail. I could do nothing because my father did NOT understand what CODE STATUS meant.

Eighteen years later I still can't find anything on the WWW that gives an understandable explination of Code Status.

]Note: this is my first post to a nursing forum in years, so please forgive me if I am out of line. :redbeathe