Advance Directive question

Grady_emt

Grady_emt

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Ok, so the other night we were called to a nursing home for a 84yof c/o rectal bleed. She has been a resident for 10 years of this home, is a hospice pt, is completely AxO. Staff states approx 45minutes PTA EMS, when changing pt, they noticed bright red blood in it. Pt has hx of CVA, Lung Cancer, and Htn.

In her paperwork was her DNR, as well as advance directive. On her advance directive it had several check-boxes, all checked "no" CPR, Intubation/Advanced airways, IV Fluids/medications, Hospitization, Intramuscular Injections, Internal feeding tubes

My issue was with the "Hospitization" box. Does this mean take the pt to the ER for evaluation, and not be admitted? Or not to the hospital at all?
 
Alert and Oriented
 
With an alert and orientated patient, there is no need to refer to the documentation. Just ask the patient.
Here in Wisconsin, advance directives have no legal weight. We are not lawyers. If we work a code, there is no half hearted measures... cannot do a "partial" resuscitation. A valid DNR is of course, totally respected. Generally, in the case of an unresponsive patient without a valid DNR, we work the code. The law gives us no other alternative.
 
Thats the same as above post here. If the patient is Cx they can tell you if they are willing to go to the hospital or not. DNR is not pertinent here in this particular case.

MDKEMT
 
usually, and i do use this term lightly. usually no hospitalization means no long term hospital care...but if she wants to go....then take her.
 
DNR does NOT mean do not treat. More clarification should be made on the chart or documentation. Usually, aggressive hospital care means no ICU or "heroic" measures to be made. As well, many hospice have regulations NOT to place patient in the hospital, hence the reason the Hospice was contracted. Hospice is paid to take care of the patient, if they are admitted due to the related condition, then Hospice looses the money & is responsible for the bill. That is why Hospice is responsible for paying for the medicines and care..

They (Hospice) rather attempt to treat as much under their care.
 
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