Dnh/dnr

[jemt]

In response to the initial post. Why if you were transporting a patient to a SNF and did have the DNR in hand and the patient started going downhill enroute, then why did you not divert to a the most accessible receiving facility/ER and instead took the patient back to a SNF? If a patient is deteriorating while being transported and you do not have a do not hospitalize order in hand, then the patient needs to go to an ER and not SNF.

I am a major advocate for patient's rights and DNRs but transporting a patient that is deteriorating back to a SNF in hopes of consulting with the nurse there or finding a DNR sounds like bad patient care to me.

This patient is in her late 90's and not completly with it to begin with. If you try to say anything to her all you get is a hi and thats it. Also many PT's I transport are normally weak after Diaylsis and her vital signs were all fine. On this day she wasn't responding verbally but reconized I was talking to her.

I wasn't insinuating she was crashing rapidly but that she wasn't herself this particular day. I asked to nurse if she wanted us to transport to the E.R. because she seemed overly concerned.

 

[Bullets]

Then, ideally, you should make a duplicate copy of your PCR for the ED. After all, copies, be them carbon copies or photocopies, are often poor quality. Why should the ED accept care of your patient if you aren't willing to make them an original of your PCR? Oh, and make sure to include enough originals for the floor unit and what ever facility the patient is discharged to.

A DNR is a long term document that is needed in multiple charts. Why should a SNF give you the original when they need the original for their chart? The patient's wishes shouldn't depend on a game of "who has first" and ensure that a single document is properly tracked and handed back and forth.

thats why we use ePCRs, once i upload, they go into the hospitals server and are available to anyone in the building

I just need to be able to read the patients name, and cant be a xerox of a xerox of a black streaked xerox

And the whole family request thing, that just seems hinky

 

[btkspot89]

I know im chiming in a little late here and I apologize, but I have came across these DNH's on numerous occasions. Anytime I run in to them I always have some sort of problem. Now in EMT class they teach you about the DNR, but when I ran into a DNH order it caught me off guard. The first time I was called to one of our contracted facilities for a patient who was refusing to eat. The staff at that facility tried to force feed the patient and almost made him choke, so they called us. The patient was alert and oriented and refused to go to the hospital. Also when I checked the paperwork I came across this DNH order. When I questioned the staff at that facility as to why they were ignoring a signed doctors order to not send the patient to the hospital. They tried to act like they had never seen the paperwork before. So after about 10 minutes of the staff talking they decided to call the doctor, who backed up his signed order. The family got there and while they tried to talk to him as well the patient still said "no" So with a patient refusal and a seeing a signed DNH we left.

Now this brings up my question which im pretty sure I know the answer too. Can the staff at an extended care facility override the patients orders?

 

[JPINFV]

Can the staff at an extended care facility override the patients orders?

Provided the patient has capacity and there isn't any sort of special legal order (like a conservatorship in California. Power of attorney only goes into effect if the patient lacks capacity/is incapacitated), no.