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How would you deal with a Hospice Patient?


EMS2712

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I believe a Living will is what you are referring to. I have one. It is very specific as to what procedures I am willing to accept and also when to disconnect the machines. I did this so my family will not have to make the difficult choices during an already stressful situation. It is different than a DNR.

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A DNR IS NOT just for when a patient codes. It can state anything the patient wants in regards to their treatment. A patient can have DNR that says they don't want oxygen more then 10li/min.

Can you provide any sort of documentation to support this?

Sounds like you are talking about an advanced directive or health care proxy as opposed to a DNR

*edit* Seems like this was already addressed slow typer this morning lol

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To the OP,

Only care wanted should be rendered, If the family/patient only want assistance getting up should help them get up, and get a RMA based on your local protocol.

I can't count the times families panic and call 9-1-1 when their family member is dying, even though the family member has a DNR. The family just doesn't know what else to do.

Edited by tskstorm
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All of that can be stated in the DNR.

No. I have a Living Will for myself which is very specific and expresses my wishes. I do not have DNR orders yet. A Living Will, as spenac is stating, provides for decisions of continuing care by specific means such as dialysis or feeding tube And, it addresses discontinuing care and can be very specific for when that determination is to be made. A DNR can then take in affect.

If a patient was placed on life support and the family presents the patient's requests by Living Will the patient can then be made a DNR while on life support in the event the patient's BP drops or the heart stops. It can then be determined if the patient will be a withdrawal of life support for end of life or comfort care measures which could be the next step.

It's called an example. You should really read up on things before you go running your gums.

Before insulting someone, you should also understand the many variations there are and how YOU will be challenged legally if you do not.

Ignorance is not a good defense to claim in a court of law.

Edited by VentMedic
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This is why I posted this for discussion. I wasn't directly on the run, but as it as explained to me after the run because I QA our runs. To answer the questions that I was asked. Patient was an 86 y/o male on end stage heart failure with a cardiac output of less than 25%. This was dispatched as a public assist, and subsequently our crew was asked to evaluate his condition. I was advised by my crews that he was lethargic. Family has Medical POA. In addition, the family was advised by hospice for them to maintain hospice care, they have to notify hospice if something goes wrong and they will decide whether the patient will go to the hospital. I wasn't aware of this, but upon further consultation with a couple of Dr's and Training Coordinators, in some Hospice systems you give up your rights to determine care because a lot of times the families will make decisions with emotions instead of following the patient's wishes. This also includes in whether 911 is called. I wasn't aware of this. I don't agree with this though. Please don't get me wrong, but I feel that the family(and the patient for that matter) still has a right to say in their care. Hospice does a lot of good work, but I don't think it is appropriate in this case. The crew was told that he was put on hospice because of the end stage heart condition, but they (hospice) is also giving him 25mg Morphine daily. What are your thoughts? I think this could be a good debate.

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DNR does NOT mean do not treat as so many seem to have the impression of. If you can do non invasive measures to make him comfortable, go for it, if not, then don't pursue it. Think of it this way and pose this question to hospice-

The patient has a relatively minor infection, but requires treatment with IV antibiotics. They take him to the ER because he is running a high fever where he gets diagnosed. He could easily be treated with the antibiotics and live comfortably for several more months. Don't you think the patient might want that? If the patient is capable of saying what he wants - ASK HIM ! It's his life and despite what his family says and the concerns of hospice, if the patient wants to be treated and possibly extend his life, then you MUST under a legal and moral duty honor those wishes despite what you think just as if he says no you must. Just things to turn over in your mind.

One other thing, many families of patients on hospice care panic when things start going downhill - they get scared because the reality that their loved one is going to die is finally sinking in. The best thing you can do (especially if family has POA) is to be as supportive as possible, contact your med director, and also contact hospice for assistance. Ultimately though, it is about patient care AND dignity which is what hospice is supposed to be all about. Remember your license is on the line, so that's why I do say involve your med director and it never hurts - and document, document, document !

Edited by fire_911medic
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I wasn't aware of this, but upon further consultation with a couple of Dr's and Training Coordinators, in some Hospice systems you give up your rights to determine care because a lot of times the families will make decisions with emotions instead of following the patient's wishes. This also includes in whether 911 is called. I wasn't aware of this. I don't agree with this though. Please don't get me wrong, but I feel that the family(and the patient for that matter) still has a right to say in their care. Hospice does a lot of good work, but I don't think it is appropriate in this case. The crew was told that he was put on hospice because of the end stage heart condition, but they (hospice) is also giving him 25mg Morphine daily. What are your thoughts? I think this could be a good debate.

Look at this from the patient's point of view. He is not giving up his rights by entering Hospice. He is exercising his rights to die as he has chosen. He knew he was 86 y/o with cardiac failure, no quality of life and will die eventually. By having the decisions made earlier and putting his doctors and Hospice in control, it relieves the family's stress and prevents more suffering for him. Hospice is not taking his rights away but seeing his rights are followed through and ensuring his comfort in his home as he wanted it.

If the patient is taken to the hospital, the family may have even less control and the patient will definitely lose his rights to make any further decisions since he can no longer vocalize or will be intubated on a ventilator. This is going against the decisions he had already made but may now have his rights to his decisions taken away by someone(s) who has issues with how he has chosen to die.

The issue should be about the patient. It shouldn't be about what the EMS providers' own personal beliefs are. Choosing Hospice is not done on some whim like choosing an HMO or a new car. Before a patient enters hospice, there will be many participants in this decision making process to assist the patient and the family.

Edited by VentMedic
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