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Oedgar23 Posted March 2023

Beware of this when getting an out of hospital DNR.

My beloved dad died a year ago at age 73 due to liver cancer. He went from taking cruises one month and having years of stable blood work to dying within a months time. I reluctantly put him in a small care home with hospice services. This was right before New Year’s weekend. They basically came and did a cursory intake of him and left the comfort pack with the care staff.


We visited and spent most of our waking hours at his bedside. His care home place was five minutes from my house so I did not feel bad doing this. I also have a number of chronic pain issues, and had just been through a surgery for which I did not get to receive PT due to his becoming ill. I just was not physically in the shape to sit with him 24 hours a day. His room had no seating, except for a very uncomfortable recliner.


I made sure that a DNR was signed. I had to prompt the hospice company to get the paperwork for me, and I did it with my spouse and my brother's spouse as witnesses. I turned the paperwork in the Friday before New Year’s weekend.


He declined over the weekend, sleeping more and more, but he had moments of alertness and was still getting up to use the bathroom with Assistance and a huge effort on his part.


My brother and I spent that Monday with him. Finally, his hospice nurse came and did a thorough assessment and we got some good plans going for a better bed for him and medication given and a plan for anti anxiety meds etc. I stayed in bed that evening, but my brother sat with him until about 10 PM.


 


I received a panicked call from the hospice nurse at 2:50 AM. He had gotten up to the restroom and actually collapsed on the young aide who was helping him. EMS had been called and they were doing CPR because the hospice doctor failed to sign the DNR. Therefore it was considered incomplete. They made me come to the facility as his POA to tell EMS to stop.


By this point, my brother from out of town was staying at my house. We all rushed out of bed, threw some clothes on and drove over. I was ushered down the end of the hall where his room was. There were a lot of people in there and all I could see, was his bare chest rising and falling as they did compressions with some sort of a machine.


I could only say “No. None of this. No more.” It still took them a bit of wrangling and calling somebody I guess one of their bosses for them to stop CPR.


I really can’t believe that this fell through the cracks, but in someway I can. Covid was ramped up at that time. The hospice staff had already told me that they were very short staffed, plus it being a holiday weekend. The paperwork just did not get done on their end.


I did my part, but it fell through the cracks anyway. So the moral of the story is check with hospice and make sure their physician has signed the paperwork.


My sweet dad did not deserve to die like that.

Grandma1954 Mar 2023
I was told by my doctor recently that a POLST (more detailed than a DNR) does NOT have to be signed by a doctor.
And actually the Care Home was at fault for the phone call. Once someone is on Hospice the instructions from Hospice are "DO NOT CALL 911" Hospice is now the first call that is made. They make the determination if 911 is to be called. In most cases they will send a Nurse to evaluate the situation.

Geaton777 Mar 2023
My elderly Aunt had DNR paperwork at her home where she was receiving care. She fell, broke her hip and was transported to the hospital, then to a rehab facility. The facility made us get a new DNR that was signed by her actual doctor (the original one wasn't but what difference does this make??). I was shocked by this red tape. Not sure why her original one wasn't valid "enough".

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AlvaDeer Mar 2023
Your warning is well written, well taken, and will help others. If a patient is in hospice, and even if someone is older (as I am at 80) a POLST should be done. You will be left with a copy to hang on your refrigerator. Mine is on the inner door of the broom closet as I don't want to look at it each time I get cream out for the coffee, but have it close by, and anyone who calls EMS should know where it is to get to at once. I am told some states don't allow them, but they are basically a paper done with YOU and with your DOCTOR, a doctor's order, that this can be done and that cannot.
Otherwise, as you observed, by LAW EMS must attempt to resuscitate.
Thanks for this warning.

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