Woman Dies After Nurse Refuses to Do CPR

[Chowder Head]

http://blog.aarp.org/2013/03/04/woman-d ... -to-Do-CPR

:o :pink-shock: just no words

[IamCanadian]

There's talk in the comment section that the woman had a Do Not Resuscitate order on file.

[laura oz]

If she had a DNR it makes sense. My grandmother was a RN at several assisted living centers, and the ones she worked at required all personal to have a CPR certification. I'm more surprised that the facility could get anyone to sign the no CPR agreement. If I was moving in one of these facilities, I'd want them jumping up and down on my chest to keep me alive. Unless I had a medical condition that precluded me from enjoying life. Then I'd just want to let go.

ETA I need to pay attention to spelling

[dairyfreelife]

There's talk in the comment section that the woman had a Do Not Resuscitate order on file.

I was wondering the same thing. My guess is that was the case. Hope so.

[J'ean Skirt]

I was wondering the same thing. My guess is that was the case. Hope so.

This happened about 6 months ago.

Lorraine Bayless lived at a Bakersfield (CA) continuing care community called Glenwood Gardens, but in independent living, not in its skilled nursing facility. She did not die of a heart attack but of a stroke, according to the death certificate signed by her personal physician. CPR may have saved her, but it is very unlikely.

And there is more. Mrs. Bayless did not want life-prolonging medical interventions, and her family is fully satisfied with the care she received. And the staffer who called 9-11 may not have been a licensed nurse at all. One piece of the story is true: Glenwood Garden staffers are prohibited from performing CPR or other medical interventions and are instructed to call 9-11 in the event of emergencies. www.forbes.com/sites/howardgleckman/2013/03/06/the-cpr-death-at-glenwood-gardens-what-really-happened-and-five-lessons-you-should-learn/

The family is happy, the police closed the investigation.

[Coconut Flan]

Thanks for the info.

[salex]

If she had a DNR it makes sense. My grandmother was a RN at several assisted living centers, and the ones she worked at required all personal to have a CPR certification. I'm more surprised that the facility could get anyone to sign the no CPR agreement. If I was moving in one of these facilities, I'd want them jumping up and down on my chest to keep me alive. Unless I had a medical condition that precluded me from enjoying life. Then I'd just want to let go.

ETA I need to pay attention to spelling

A Brother in law's father had a DNR in his assisted living facility. When he had a heart attack (I think) they called the ambulance and someone (either facility staff or EMT or someone) did resuscitation in spite of it. He ended up in the intensive care ward, with tubes and machines and begging them (via the pad he could write on, as he couldn't talk with the tubes) to take him off the equipment. He was old, unwell and had no intention of surviving a traumatic event. What we've been told is that it is ALWAYS easier not to be put on the machines than to be taken off of them. Eventually, either they didn't put the next helpful appliance on him or they removed a couple and he had another attack and died in the hospital, but while his life was extended for a few days, they were not days he would have missed had he not had them, based on his reaction to waking up alive.

[Minerva]

Very understandable if the woman had a DNR. I'm a bit shocked that staffers are prohibited from performing CPR, though. I can see how allowing CPR to be performed could make it harder to respect DNRs and open them up to lawsuits if someone makes a mistake while performing it, but I don't think I could live with myself if I was the person who instituted a blanket ban on CPR. Maybe I'm missing some information...

[OkToBeTakei]

Very understandable if the woman had a DNR. I'm a bit shocked that staffers are prohibited from performing CPR, though. I can see how allowing CPR to be performed could make it harder to respect DNRs and open them up to lawsuits if someone makes a mistake while performing it, but I don't think I could live with myself if I was the person who instituted a blanket ban on CPR. Maybe I'm missing some information...

This is my kind of job at the moment. We call it DNA.CPR and with that comes a clear path of understanding that the person or if they lack capacity their legal guardian and or GP deems it in the best interest then it is so.

Example would be if some agency nurse called 999 the database will say that X McD does not want extraordinary measures to prolong his life. Nurse has not done anything wrong but all agencies are clear on the directive.

To have a DNA.CPR in place you have to have an End of life Care plan. Or Anticipatory Care Plan. Legally in my country this can be done by 2 consenting health professionals, not family. Family is the preferred route but that is so hard. In my experience they actually do not want to make that decision.

As a nurse and I may sound a bit strange, my however disturbing it may be to others is to give somebody a pain and anxious free death. If I manage to do that I feel I am doing ok.

Jumping up and down on a fragile elderly chest is not what I think is compassion. It's cruel.

[Minerva]

This is my kind of job at the moment. We call it DNA.CPR and with that comes a clear path of understanding that the person or if they lack capacity their legal guardian and or GP deems it in the best interest then it is so.

Example would be if some agency nurse called 999 the database will say that X McD does not want extraordinary measures to prolong his life. Nurse has not done anything wrong but all agencies are clear on the directive.

To have a DNA.CPR in place you have to have an End of life Care plan. Or Anticipatory Care Plan. Legally in my country this can be done by 2 consenting health professionals, not family. Family is the preferred route but that is so hard. In my experience they actually do not want to make that decision.

As a nurse and I may sound a bit strange, my however disturbing it may be to others is to give somebody a pain and anxious free death. If I manage to do that I feel I am doing ok.

Jumping up and down on a fragile elderly chest is not what I think is compassion. It's cruel.

So basically when you call emergency services, you can find out directly whether the person has a DNR? That sounds very useful. Is this a UK-wide thing, or is it only available to to hospitals and such?

I agree about the bolded. CPR can break anyone's bones. Once I've had a good long life, I don't want to wake up to a whole bunch of broken ribs. Now? Sure, I'd be happy to risk a broken rib if it means not dying young. Probably not when I'm a little old lady with osteoporosis.

[Mela99]

There has to have been DNR, that is the only reason this makes sense...

They'd be opening themselves up to massive lawsuits and criminal liability otherwise.

[treehugger]

DNR's are common in nursing and retirement homes (at least here in Canada). In all the homes I've worked at, if the residents have a DNR, all the staff knows about it, and it is posted in their files.

[CelticGoddess]

I left my PRN job at a skilled nursing facility due to a situation where I was told I would have to do CPR on a patient with DNR orders because the DON did not get the papers signed for the facility. (He was actively dying so I called the residents POA and had her come in to refuse treatment. This man had end stage renal failure and CHF) Sadly, this kind of thing happens all the time in LTC, Skilled Nursing and Assisted Living all the damned time. Most of the assisted living facilities in my area will allow staff (and actually require) to perform CPR on those residents who do not have DNR orders.

Unfortunately, once CPR is iniated, it has to be continued (at least in SC) until EMS arrives (and they have to continue CPR for 30 minutes) or a doctor declares the person clinically dead. Even with DNR orders.

Lesson here: One, always make sure that CPR will be performed on a loved one if that is what is wanted! and make sure that the facility doesn't pussy foot around and forget to get DNR orders signed when requested.

[bookiewookie]

My grandpa had a DNR in place and my grandparents were advised to tape the envelope containing it to the fridge so that the EMT's would know to look for it and wouldn't accidentally perform CPR.

[Hane]

My mom, who was in home hospice care, had a DNR. When she stopped breathing, my BIL mistakenly called 911 instead of the hospice nurse. The fire department crew who came believed us when we said she had a DNR (which we couldn't find in the confusion) and didn't take any aggressive action.

Thank you, bookiewookie, for the recommendation about taping the DNR to the fridge!

[salex]

My grandpa had a DNR in place and my grandparents were advised to tape the envelope containing it to the fridge so that the EMT's would know to look for it and wouldn't accidentally perform CPR.

An aquaintance of mine is seriously thinking of having hers tattooed on her chest..... she is not aging well, has had cancer a couple of times and sufferes from chemo related issues, can't walk any longer and has other health issues. She isn't planning suicide, but she says if I die, let me die.... she is in a retirement community apartment, having given up her home in the last year. She has worked in mental health care and medicine most of her life, and pretty much knows what the future looks like.

[rward]

So basically when you call emergency services, you can find out directly whether the person has a DNR? That sounds very useful. Is this a UK-wide thing, or is it only available to to hospitals and such?

Part of Obamacare was supposed to be digital health information available on the fly, anywhere. This was of course immediately shot down by the GOP and a good portion of the (paranoid) American public, but it would have allowed for exactly what OK describes, which would be a good thing. As it stands now, having a DNR in the US is functionally useless, because nobody but a very few will know about it and once you're hooked up to the machines, good luck getting off them.

[OkToBeTakei]

Part of Obamacare was supposed to be digital health information available on the fly, anywhere. This was of course immediately shot down by the GOP and a good portion of the (paranoid) American public, but it would have allowed for exactly what OK describes, which would be a good thing. As it stands now, having a DNR in the US is functionally useless, because nobody but a very few will know about it and once you're hooked up to the machines, good luck getting off them.

The NHS is digitalised. Hence after my hospital stay and on a routine visit to my GP he called up my information on his PC. Lab/diagnostic results meds etc. along with the gem that 'Miss OK appeared to be anxious to get home' Well yes...I was :lol:

My NHS trust has been rolling out the ACP premise for over a year so if you were to phone for an ambulance or out of hours GP then if a DNA-CPR is in place it would immediately be flagged. Obviously the GP would be aware so the only time it may be missed would be in an accident or the first line arrival team could not ascertain the patients name. Nobody would in the event of an accident leave somebody in pain or untreated and serious RTA' S involving a person ill enough to have DNA-CPR in place makes it academic anyway.

The point of the ACP is for the patient whilst they have capacity to say 'Look' I don't want to go to hospital but if I call 999 for pain or other reason out of hours I want this treated. In the case of elderly patients it may be do not take me out of my home (if they have a home care package) I don't want admission or IV antibiotic I'll stay home and take my chances with an oral course (Yes I did actually see that as a choice.) Some people have such a strong desire to remain in their own comfortable environment and as long as their choice is made in an informed way I really believe it should be honoured. Fractures or other injuries are the most common accident in the elderly and an admission the most single reason why dementia symptoms take a real dip post operatively. Having a prompt surgery and maximum support at home can lessen the impact. Fro the NHS the cost is less to have professionals such as OT, Physio, Wound Care specialist, etc etc do community based home care than to have an inpatient.

I cannot speak for other NHS trusts but as these type of directives roll out at different times it will probably be a standard in the future.

I have already planned my ACP. :lol:

[Hane]

My parents decided to have living wills with DNR instructions after they learned what happened to my uncle. He was in intensive care for months after his cardiac bypass surgery went badly awry. My aunt saw firsthand the trauma he went through when his heart stopped and they applied the defibrillators: the skin of his chest was actually burned and bruised. That's when she decided never to have him endure that again.

[Three and Done]

I am a certified EMT in my state, and during our training it was impressed upon us to always look on the fridge for DNR's and other medical information.

I would encourage all of you to place any important medical information (especially drug allergies!) in a clearly labeled envelope on the front of your fridge.

[Coconut Flan]

I would encourage all of you to place any important medical information (especially drug allergies!) in a clearly labeled envelope on the front of your fridge.

Thanks. I had no idea.

[pikachu]

An aquaintance of mine is seriously thinking of having hers tattooed on her chest.....

In my state, a tattoo would not be a valid DNR. We have to have state-issued, physician-signed DNR form. If I had a patient with a DNR tattoo, but no state form, I would be legally obliged to perform CPR and all life-saving measures as appropriate.

I have to say, it is a horrible feeling, the sensation of elderly ribs cracking under my hands as I do CPR. I wish more people knew how futile it is for many patients, and how it may prolong suffering. I believe many would wish for a peaceful death if they knew what was involved.

[Beammeup]

I am a certified EMT in my state, and during our training it was impressed upon us to always look on the fridge for DNR's and other medical information.

I would encourage all of you to place any important medical information (especially drug allergies!) in a clearly labeled envelope on the front of your fridge.

Also a copy taped to the dashboard of your car. Medical alert jewelry as well. My mom is an EMT and did CPR on a patient with a DNR after a car accident. Don't tape the note directing responders to look for the documents on an airbag cover.

I've done CPR when I trained as an EMT. I broke ribs that first push down. They don't tell you that in CPR class. CPR with fast defibrillation has some success. CPR by it self doesn't work in but a miniscule of cases. I'm not sure I would want it on me.

[salex]

In my state, a tattoo would not be a valid DNR. We have to have state-issued, physician-signed DNR form. If I had a patient with a DNR tattoo, but no state form, I would be legally obliged to perform CPR and all life-saving measures as appropriate.

I have to say, it is a horrible feeling, the sensation of elderly ribs cracking under my hands as I do CPR. I wish more people knew how futile it is for many patients, and how it may prolong suffering. I believe many would wish for a peaceful death if they knew what was involved.

I suspect this friend will have the correct things at hand.

[ADoyle90815]

In a way, I'm glad my grandma has a DNR because she's a frail 90 year old, and I think that trying CPR on her would be extremely cruel. It was bad enough that we had to turn off the machines to let my grandpa die after a series of heart attacks, so my hope is that my grandma gets to end her days in hospice, preferably at home or at least, in a center that only provides hospice care.