DNACR - Hospital

Discussion in 'Legal and financial issues' started by Louise7, May 23, 2018.

  1. Louise7

    Louise7 Registered User

    Mar 25, 2016
    433
    Quick query. If a DNACR decision is made in hospital should they discuss this first with the H&W POA to allow them to make the decision or can they just go ahead and make the decision without letting the POA know?
     
  2. 70smand

    70smand Registered User

    Dec 4, 2011
    198
    Female
    Essex
    As far as I’m aware Dr’s should always discuss this with the person or their next of kin/ H &w POA first, as the document does mention who it was discussed with.
     
  3. SiJol

    SiJol Registered User

    May 23, 2018
    12
    You definitely need to talk to the doctors about this.
     
  4. 70smand

    70smand Registered User

    Dec 4, 2011
    198
    Female
    Essex
    But saying that I’ve always understood it to be the dr’s decision not to perform CPR if it he feels it would not be suitable.
     
  5. Louise7

    Louise7 Registered User

    Mar 25, 2016
    433
    Thanks for the replies. Within the POA Mum specifically authorises myself and my sister to give or refuse consent to life-sustaining treatment on her behalf. However I have just discovered that there is DNACR form in my Mum's hospital file (which I haven't seen yet) which we were unaware of until now, and the DNACR decision was also not communicated to us. I appreciate that it is ultimately the doctor's decision not to perform CPR should the situation arise but it doesn't seem right that a DNACR decision could be made by the hospital without first discussing this with those who hold H&W POA.
     
  6. LynneMcV

    LynneMcV Volunteer Moderator

    May 9, 2012
    2,865
    south-east London
    I can understand why you are upset about finding out about the DNR the way you did.

    I have had the DNR conversation three times now - once in January with my husband's consultant at the Community Mental Health Team, a few days later at the hospital he was admitted to in January - then a few days ago at the current hospital he is in. I had thought that once it was on his file once that would be it, but I was told that they are not transferable and can expire.

    Thinking back to all three conversations, although I was involved and fully briefed as to why a DNR would be in my husband's best interests, I was never actually asked for my permission (not an issue in our case because I was fully behind the reasons given - having said that, I suspect I would have been overruled had I objected). Also, I was not asked to sign or witness anything as POA - it was the doctor alone that signed the form - again leading me to think that that final decision is with the most senior health professional.

    Looking at one of the forms I currently have, while there is a section to summarise what communications were made with the patient or POA it also gives an opportunity to state why any such decision has not been discussed. So, it would seem there are situations when that might happen.

    Forgive me, but I don't know your mother's exact situation - was she deemed to still have mental capacity at the time the DNR was issued? If so, the medical profession would have discussed things directly with her as the H&W POA doesn't come into play until all mental capacity is lost.

    It's also worth knowing that DNRs are not automatically permanent. The one I have has a section where a review date can be entered although, in my husband's case, this has been given as 'indefinite '
     
  7. Louise7

    Louise7 Registered User

    Mar 25, 2016
    433
    I don't know the exact date the DNR was issued but Mum did not have capacity when she entered hospital, for treatment to a cut face, and was some way off being 'end of life'. She has previously been diagnosed with bradycardia and in November the hospital stopped her dementia medication in case it was causing the bradycardia, stating that a referral back to cardio was required - potentially for a pacemaker to be fitted - if it continued after the medication was stopped, which it did. Bradycardia is a heart problem but is easy to resolve with either medication or a pacemaker - it is only potentially fatal if left untreated. Long story, but Mum subsequently ended up spending 3 months in hospital during which time I kept being told that a referral to cardio was 'in progress', then more recently that the referral had been made. However Mum has now been discharged, with the discharge letter stating that the referral to cardio had been made, but I have since discovered that it hasn't. Treating the bradycardia would make a real difference to Mum's quality of life as well as her general health as she has been having falls which appear to be related to the heart problem.

    It's not really a case of being upset. Finding out that a DNACR has been put in place without the family's knowledge, when considered against all of the other issues that took place in hospital, including not making a referral to cardio so that Mum's bradycardia could be treated, is really concerning.
     
  8. Kikki21

    Kikki21 Registered User

    Feb 27, 2016
    1,202
    Female
    East Midlands
    This is why organisations such as PALS exist in hospitals & unfortunately I had to refer to them twice as the hospital unsafely discharged my mum would could have led to her suffering a huge seizure at home & led to her further admission to hospital an hour after she had left!
    They tried to discharge her on several more occasions so I had to complain to PALS, I also couldn’t get to speak to anyone about her condition while she was in there & again uses PALS to complain. Wards don’t like you involving them but once I got stuff clarified, met with her consultant & the ward manager, things settled down & were ok. You sound like you have been fobbed off.
     
  9. Louise7

    Louise7 Registered User

    Mar 25, 2016
    433
    Yes, I was fobbed off for months. I did go to PALS when I discovered that the hospital had been keeping Mum bed bound even when she was fully mobile, leaving her in severe pain, and this did result in the staff immediately getting Mum out of bed. I also went to them again about the delay in the referral to cardio. However it didn't go down well, and I was informed by the consultant that going to PALS had delayed things for Mum, as he had to answer the complaint rather than make the referral to cardio. He also made the comment that "there wouldn't be all these problems if you looked after Mum yourself"!

    I only became aware of the Do Not Resuscitate issue after Mum had been discharged, so didn't refer this to PALS. We couldn't understand why Mum was being kept sedated on morphine when there was no medical need and it was causing her to stop eating & drinking, yet the staff were insistent that it "was the best course of action for her". Knowing now that they had put a DNR in place, made no attempt to refer Mum to cardio and were unnecessarily sedating her is really concerning.

    For info, I have since discovered that it is unlawful for a DNR to be put in place without first discussing with the patient or family/POA/carers if the patient lacks capacity (unless the doctor makes the decision during an emergency situation).
     
  10. Kikki21

    Kikki21 Registered User

    Feb 27, 2016
    1,202
    Female
    East Midlands
    Just simply awful! I discussed DNR with the consultant as he asked me. But as you point it, DNR there does not mean DNR everywhere & I have since had a discussion with my mum’s GP & we have a DNR & care plan in place & are on the same page.
     
  11. DeMartin

    DeMartin Registered User

    Jul 4, 2017
    653
    Kent
    0BE37902-934D-49FE-8523-8186A0D09CB0.jpeg This letter arrived today. Talk about curt! I think it could be better worded.
     
  12. marionq

    marionq Registered User

    Apr 24, 2013
    4,620
    Female
    Scotland
    That looks very like the form which John was given six years ago when first diagnosed with Alzheimer's. I remember he asked not to be rescuscitated but to be given antibiotics if appropriate. It was a person from SS who was completing his records and I have no idea where the DNR form ended up. I imagine if he was hospitalised I would have to make the decision now.
     
  13. Louise7

    Louise7 Registered User

    Mar 25, 2016
    433
    Not a very sensitively worded document but at least you are being asked. In my Mum's case I have requested the date that the DNACR was put in place, who by, the reasons for the decision and why the decision was not discussed with or communicated to Mum's family who held POA. I am still awaiting a response a month later.
     
  14. nitram

    nitram Registered User

    Apr 6, 2011
    15,908
    Male
    North Manchester
  15. Louise7

    Louise7 Registered User

    Mar 25, 2016
    433
    Just an update as I have now finally managed to get a copy of the DNACR form which was placed on Mum's hospital file without the family's knowledge. One of the reasons given for the decision, apart from Alzheimer's, was 'over 2 years in 24hr care', but Mum had been in 24hr care for less than 6 months. It also states that the consultant discussed it with me and I fully agreed with the decision, despite no such discussion taking place..........
     
  16. philamillan

    philamillan Registered User

    Feb 26, 2015
    99
    This is complex and never easy to solve with families.

    The Do Not Resuscitate (DNACPR) document was designed to prevent inappropriate interventions in a person who would not want or benefit from these actions.

    Resuscitation is specifically about the heart stopping or lung (Respiratory) failure. The reason it is important is that if a person does not have such an order and their heart stops, the automatic response is to start Cardiopulmonary resuscitation.

    This means chest compressions (willing to break a few ribs if the person is frail) and potentially putting in a tube for breathing and sometimes a ventilator. It is not pleasant and very traumatic to the person often with poor results.

    People confuse actively treating someone who is sick with resuscitation. The question is, if after adequate treatment this person continues to deteriorate should it be appropriate to intervene further.

    Sadly the most important point gets missed. Sometimes resuscitation works! However in an already unwell person we can get the heart working again but has there been permanent damage to the brain before or during resuscitation. Very sad to see a person resuscitated but with brain damage. There is very little that can be done at that point.

    However your responsibility is to advocate for your relative and if the DNACPR has been placed there is no reason why you cannot challenge it.

    Doctors are allowed to make a clinical decision regarding resuscitation but good practice dictates discussion with the next of kin.

    Hope this information was useful.
     
  17. Louise7

    Louise7 Registered User

    Mar 25, 2016
    433
    Thanks, I'm aware of all that and the point isn't that we necessarily disagree with the decision, it's the fact that no-one discussed it with the family and then lied on the form to say that they did. We couldn't challenge it at the time because we didn't know it was there. Mum gave us POA so that we could speak up for her and act in her best interests when she wasn't able to do so herself. If the hospital just ignore a H&W POA what's the point of having it? :(
     

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