@ShaunLintern Wolverhampton

Help: can a do not resuscitate order be put on a dementia patient without any discussion with family? what are the rules on dnars?

1:01PM Thu, November 03 2011

@DoconaLimb England

Comes down to patient's best interests, as I understand it. Family cannot over-ride anyway unless have legal power.

1:04PM Thu, November 03 2011

@dandelion101

I shouldn't have thought so. Need next of kin, surely

1:06PM Thu, November 03 2011

@PeteDeveson South London

@ShaunLintern "Responsibility rests with the most senior clinician" http://t.co/kj8QMhx7

1:08PM Thu, November 03 2011

@spritesbites

I looked this up last year for a friend whose wife was ill. Drs are allowed to withhold treatment without permission

1:11PM Thu, November 03 2011

@spritesbites

... if they feel the witholding of treatment was in the best interests of the patient. My friends wife died. She was only 52

1:11PM Thu, November 03 2011

@spritesbites

basically they are in charge and there is sod all you can do about it.

1:12PM Thu, November 03 2011

@nursedonovan on the edge of cannock chase

should discuss it but decision is a medical one as I understand it

1:15PM Thu, November 03 2011

@drjohnbye UK

yes, but not best practice

1:15PM Thu, November 03 2011

@nursedonovan on the edge of cannock chase

but they ought to discuss it with the patient

1:16PM Thu, November 03 2011

@nursedonovan on the edge of cannock chase

any doubts about patient they should be doing a mental capacity assessment

1:16PM Thu, November 03 2011

@nursedonovan on the edge of cannock chase

there must be a dr on here who can give definitive advice

1:19PM Thu, November 03 2011

@ShaunLintern Wolverhampton

@DoconaLimb Thanks. It would appear drs can do it but should discuss it with family.

1:21PM Thu, November 03 2011

@ShaunLintern Wolverhampton

Thanks for replying. It would seem you are right.

1:21PM Thu, November 03 2011

@ShaunLintern Wolverhampton

Best practice would be to discuss it with family first?

1:22PM Thu, November 03 2011

@ShaunLintern Wolverhampton

Certainly should discuss it with someone.

1:23PM Thu, November 03 2011

@drjohnbye UK

yes, patient and/or next of kin depending on patient's mental state, family complications, etc

1:24PM Thu, November 03 2011

@welsh_gas_doc South Wales

@petedeveson @doconalimb It's good practice to discuss it with family, but not necessary.

1:24PM Thu, November 03 2011

@spritesbites

sorry it was not better news. the best that can be done is talking with medical team to discuss feelings.

1:31PM Thu, November 03 2011

@PeteDeveson South London

@doconalimb @shaunlintern But does failure to speak to family constitute "substandard care"?

1:34PM Thu, November 03 2011

@alexscott292

Undoubtedly in an ITU setting. Clearly defined standards of care including communication in a variety of documents, standards

1:35PM Thu, November 03 2011

@welsh_gas_doc South Wales

@doconalimb @shaunlintern It should be done at the earliest opportunity, but DNAR can be made in absence of NoK (i.e at 2am).

1:36PM Thu, November 03 2011

@ShaunLintern Wolverhampton

Interesting. Would appear to be a moral failing as opposed to a black and white one. Family v upset and now I'm involved.

1:37PM Thu, November 03 2011

@HHAYLO Bristol

all DNAR notices are medical decisions regardless of condition. Discussion with family may be influential but not binding.

1:37PM Thu, November 03 2011

@ShaunLintern Wolverhampton

@PeteDeveson @doconalimb Thanks. Family saw form by accident and nurse said "you shouldnt have seen that."

1:38PM Thu, November 03 2011

@ShaunLintern Wolverhampton

Thank you.

1:38PM Thu, November 03 2011

@welsh_gas_doc South Wales

The important thing to remember that in a competent patient, you can not tell relatives anything without pts. permission.

1:40PM Thu, November 03 2011

@PeteDeveson South London

@welsh_gas_doc @doconalimb Actively hiding resus decision from family is not good. Nurse may be misinformed of course.

1:40PM Thu, November 03 2011

@welsh_gas_doc South Wales

So without knowing exact details, I wouldn't like to comment.

1:41PM Thu, November 03 2011

@drjohnbye UK

nb. may not be discussed with family at patient's request. Ultimately it's a medical intervention (albeit an emotive one)

1:46PM Thu, November 03 2011

@DoconaLimb England

@PeteDeveson Always good practice to discuss with family, but does not over-ride clinical best interests decision.

1:52PM Thu, November 03 2011

@_zouche_ Hampshire

DNRs must be discussed with family for dementia patients.

2:14PM Thu, November 03 2011

@ShaunLintern Wolverhampton

Cheers Pal

2:15PM Thu, November 03 2011

@ShaunLintern Wolverhampton

@PeteDeveson That definitely seems to be the consensus

2:16PM Thu, November 03 2011

@ShaunLintern Wolverhampton

Thanks. I appreciate your help.

2:16PM Thu, November 03 2011

@TheNiceLadyDoc UK

Yes eg pt v ill in nursing home might b best not to call 999. Ideally wd've disc w/ fmy before but if not, still best to dnar.

2:19PM Thu, November 03 2011

@ShaunLintern Wolverhampton

Thank you for your help. I am your latest follower!

2:25PM Thu, November 03 2011

@AnnNursingTimes London

key sentence: ‘overall resp for decisions about CPR, including DNAR rests w most senior clinician in charge of the pt's care

3:06PM Thu, November 03 2011

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Help: can a do not resuscitate order be put on a dementia patient without any discussion with family? what are the rules on dnars?

Comes down to patient's best interests, as I understand it. Family cannot over-ride anyway unless have legal power.

I shouldn't have thought so. Need next of kin, surely

@ShaunLintern "Responsibility rests with the most senior clinician" http://t.co/kj8QMhx7

I looked this up last year for a friend whose wife was ill. Drs are allowed to withhold treatment without permission

... if they feel the witholding of treatment was in the best interests of the patient. My friends wife died. She was only 52

basically they are in charge and there is sod all you can do about it.

should discuss it but decision is a medical one as I understand it

yes, but not best practice

but they ought to discuss it with the patient

any doubts about patient they should be doing a mental capacity assessment

there must be a dr on here who can give definitive advice

@DoconaLimb Thanks. It would appear drs can do it but should discuss it with family.

Thanks for replying. It would seem you are right.

Best practice would be to discuss it with family first?

Certainly should discuss it with someone.

yes, patient and/or next of kin depending on patient's mental state, family complications, etc

@petedeveson @doconalimb It's good practice to discuss it with family, but not necessary.

sorry it was not better news. the best that can be done is talking with medical team to discuss feelings.

@doconalimb @shaunlintern But does failure to speak to family constitute "substandard care"?

Undoubtedly in an ITU setting. Clearly defined standards of care including communication in a variety of documents, standards

@doconalimb @shaunlintern It should be done at the earliest opportunity, but DNAR can be made in absence of NoK (i.e at 2am).

Interesting. Would appear to be a moral failing as opposed to a black and white one. Family v upset and now I'm involved.

all DNAR notices are medical decisions regardless of condition. Discussion with family may be influential but not binding.

@PeteDeveson @doconalimb Thanks. Family saw form by accident and nurse said "you shouldnt have seen that."

Thank you.

The important thing to remember that in a competent patient, you can not tell relatives anything without pts. permission.

@welsh_gas_doc @doconalimb Actively hiding resus decision from family is not good. Nurse may be misinformed of course.

So without knowing exact details, I wouldn't like to comment.

nb. may not be discussed with family at patient's request. Ultimately it's a medical intervention (albeit an emotive one)

@PeteDeveson Always good practice to discuss with family, but does not over-ride clinical best interests decision.

DNRs must be discussed with family for dementia patients.

Cheers Pal

@PeteDeveson That definitely seems to be the consensus

Thanks. I appreciate your help.

Yes eg pt v ill in nursing home might b best not to call 999. Ideally wd've disc w/ fmy before but if not, still best to dnar.

Thank you for your help. I am your latest follower!

key sentence: ‘overall resp for decisions about CPR, including DNAR rests w most senior clinician in charge of the pt's care

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