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Not for resuscitation orders

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Author Not for resuscitation orders

fedup

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  • Joined: Sep 2005
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  • Posts: 4

Mon Dec 05, 2005 2:12 pm

Recently I came across a legal conundrum of an NFR order in my workplace. Patient A has a documented NFR . Patient A has a tracheostomy - it was blocked and needed emergency replacing . Fastest way was to call the code team to reinsert a new tracheostomy instead of waiting for the RMO to come up and letting the patient die while waiting. We did that and patient's family was called in. It is my understanding that an NFR is not for active resuscitation which was made clear when the doctors came up that patient is not for CPR . The thing is the family wasn't too happy about it - said that we needed to let him die 'comfortably ' (i.e. give morphine) even if the tracheostomy was blocked. Now the thing is that this patient was given the option that if he was given morphine- he will be almost sure to die - patient refused the morphine option way out. As far as I know - the relative of this patient who requested that we do not do anything in the situation ,has no power of attorney or guardianship. BUT the registrar wrote down that the patient is no longer for any active management in regards to his tracheostomy even if it is a mechanical obstruction. Ethically I sure as hell don't want to be watching the man dying again from a blocked tracheostomy - it was horrifying - he was really fighting for his life instead of giving it up and he refused morphine when told he will almost be surely to die.

fedup

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Dec 05, 2005, 02:10 pm

oops when I say tracheostomy - I mean the trache tube

Darren

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Your country needs you!
  • Joined: Mar 2005
  • Location: Adelaide
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Dec 08, 2005, 01:33 pm

Quite a conundrum indeed fedup.

I imagine this thread hasn't had a response because it is such a difficult issue and no-one wants to be seen to be giving legal advice.

I think that the medico is putting nursing staff in a very difficult position by those orders. To stand by and watch someone die when the intervention is really good nursing practice, not life saving heroics, would have to put doubts in your mind about where that leaves you in terms of negligence.

I guess you could seek intervention from the Director of Nursing to discuss with Director of Medical Services and have the situation clarified. At least that protects your back a little more, but at the end of the day RNs remain responsible for their own actions.

Good Luck sorting it out

 

mattycat

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mattycat
  • Joined: Jun 2005
  • Location: Davoren Park
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Dec 30, 2005, 11:42 pm

Not legal advice at all, just moral thinking... surely NFR means letting them die naturally if that happens, but not standing by and watching the devices that are meant to make it less painful choke them to death in agony. Must be some policies or precedents around on this surely - must be a common enough issue. m

priscillasmum

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priscillasmum
  • Joined: Sep 2005
  • Location: Melbourne
  • Posts: 36

Jan 02, 2006, 10:00 pm

Hi, it sounds an awful situation for all the staff. Assuming the situation is unresolved still, would you be able to request a staff meeting, with a councellor present, to discuss this issue.

I worked for many years on a renal ward, and we had regular debrief staff meetings with a councellor present, it helped all staff deal with issues surrounding dying patients.

Neil

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Neil
  • Joined: Jun 2005
  • Location: Balmain
  • Posts: 11

Jan 03, 2006, 10:32 pm

A difficult situation. The rift between nursing and doctors on what constitutes NFR again. From what I read in your post the patient is rational and able to make decisions, as he did about the morphine. So surely even if a relative says not to treat, it is surely the wishes of the patient that should be recorded in the notes and observed.

Another angle to this is should the medical staff be discussing an NFR order with relatives of a patient who is able to make rational decisions, without the patients consent, isn't that a breach of confientiality?

Nurses need to be listened to on this issue.

 

Neil

fedup

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Jan 03, 2006, 11:51 pm

The thing is that I pointed it out to the registrar who obviously was not listening and more frightened of what the relative might do . All I know is that I would never have lived it down with my conscience bugging me if the situation happened again ( which it did not) and I have had to follow the reg's orders. His face contorting as he had a mechanical aphyxiated on his tracheostomy tube and his mouth moving in the words "help me" - that reappeared in my dreams on and off during the following week. Fortunately ,the situation I went through did not happen again .The good news was that the patient was able to return home to celebrate christmas, he was asking for me but I was not around at that time, so my colleague said that she took his thanks on my behalf. My colleagues were saying if it was not for me calling that code blue - he would have been dead.

nursemorgan

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  • Joined: Jul 2005
  • Location: adelaide
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Jan 05, 2006, 08:05 pm

Hi guyswhile I'm only a student and at risk of starting world war 3 here :) My personal opinion would be that if the relative has no power of attorney then the doctors orders based on there request are not legally valid.Whilst in no way suggesting nurses function unethically, in the eyes of law "legal" ranks above "moral/ ethical" unfortunatley.Morgan

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