DNR Orders

[icowden]

Interesting article from the BBC here:-

https://www.bbc.co.uk/news/uk-65597888

But on reading a second time, something doesn't seem to make sense:-

When Robert Murray began choking on a piece of fruit at breakfast, staff at his care home called 999. He'd stopped breathing and the ambulance service operator immediately sent paramedics to attend. But seconds later, the care home told the dispatcher that the 80-year-old had a do not resuscitate form (DNR) in his medical records. The paramedics were stood down. Mr Murray died minutes later.

This is a frail elderly man with Parkinsons, choking on fruit. The care home called 999. If the paramedics had attended, the average response time for that sort of emergency is 7 minutes. Mr Murray had already stopped breathing before the call. By the time the paramedics arrived his brain would have been starved of oxygen beyond the point of recovery. Even if they had managed to get their quicker brain damage would be likely, and CPR would have been intensive and likely caused Mr Murray distress and injury (cracked ribs etc).

Thus, whilst I see the daughter's concerns, I'm not sure that the care home was wrong. At best I think they handled it badly. What say the denizens of NACA?

 

[BoldonLad]

Interesting article from the BBC here:-

https://www.bbc.co.uk/news/uk-65597888

But on reading a second time, something doesn't seem to make sense:-


This is a frail elderly man with Parkinsons, choking on fruit. The care home called 999. If the paramedics had attended, the average response time for that sort of emergency is 7 minutes. Mr Murray had already stopped breathing before the call. By the time the paramedics arrived his brain would have been starved of oxygen beyond the point of recovery. Even if they had managed to get their quicker brain damage would be likely, and CPR would have been intensive and likely caused Mr Murray distress and injury (cracked ribs etc).

Thus, whilst I see the daughter's concerns, I'm not sure that the care home was wrong. At best I think they handled it badly. What say the denizens of NACA?

Although I am elderly, I fervently hope I never end up in a Care/Nursing Home, if I do, I would obviously hope for a decent standard of care, I would also hope that my offspring would try their best to ensure I received a decent standard of care (whilst balancing their impatience to get their hands on their inheritance). It seems to me that, with some people, there is a failure to recognise that everyone is going to die, sooner or later. If I were a cynical person(?) I may think there is hope of a little compensation, to boost the inheritance pot.

Going beyond the topic, personally, I want the freedom to have a DNR in place, indeed, I would like the freedom to bring things to an end, if life was no longer worth living. It irritates me that (some) people seem to think they have the right to deny others that option.

 

[Beebo]

I think I’m with you on this one.
If you have an elderly frail patient with a DNR order it’s very difficult to pick and choose when it should apply. I imagine everyone was in a total panic at the care home.

I have a MIL in a care home with a DNR and whilst it may sound harsh, everyone has to die at some point. It’s inevitable.

 

[icowden]

I have a MIL in a care home with a DNR and whilst it may sound harsh, everyone has to die at some point. It’s inevitable.

Indeed, and I think people are often unaware of just how traumatic CPR can be.

 

[Beebo]

Indeed, and I think people are often unaware of just how traumatic CPR can be.

And the odds of it being successful.
It’s less than 10%.

 

[winjim]

I have to say I only skimmed it as I'm not clinical staff but I did read something the other week which said there was a move away from DNR / DNACPR orders in favour of a new system called ReSPECT which would appear to be this.

https://www.resus.org.uk/respect

So unless I missed it in the BBC article, which may be the case as again I only skimmed it, the journalist responsible is quite possibly a bit out of date and a bit out of touch.

 

[icowden]

I have to say I only skimmed it as I'm not clinical staff but I did read something the other week which said there was a move away from DNR / DNACPR orders in favour of a new system called ReSPECT which would appear to be this.

I think they work together. A DNACPR is a documented clinical decision whilst the ReSPECT form is an end of life care plan, which itself is a reworking of End of Life Care Planning from around 2014/15. The form itself is a little pointless as many care homes and Trusts (if not most) use electronic patient records, so you would likely at best see a version of that form. You are more likely to see a DNACPR form with the patient's bed, although depending on the intensity of care, the staff will probably be aware of who has a DNACPR in place.

 

[Bromptonaut]

The point seems to be that staff didn't understand what 'DNR' means. It doesn't mean let somebody die; it means do not subject them to traumatic CPR/AED type process. On the other hand if Mr Murray was dead within minutes then maybe the reason he choked on a piece of fruit was more than just it blocking his airway.

 

[icowden]

The point seems to be that staff didn't understand what 'DNR' means. It doesn't mean let somebody die; it means do not subject them to traumatic CPR/AED type process.

Yes, I agree. The focus seems to have been on the 999 call and paramedics which would likely have made no difference to the outcome. The care home staff should be trained in CPR and could have intervened.

On the other hand if Mr Murray was dead within minutes then maybe the reason he choked on a piece of fruit was more than just it blocking his airway.

This also seems quite likely.

 

[BoldonLad]

The point seems to be that staff didn't understand what 'DNR' means. It doesn't mean let somebody die; it means do not subject them to traumatic CPR/AED type process. On the other hand if Mr Murray was dead within minutes then maybe the reason he choked on a piece of fruit was more than just it blocking his airway.

Impossible to know, in this specific case, without more information, but, both my wife (a trained Nurse) and my younger brother (a retired Fire Fighter) have had occasion to (successfully) perform a Heimlich Maneuver, when people have choked on food in restaurants. I am ashamed to say, I have no idea how to. do this, but, perhaps it should be included in training requirements of care staff (if it is not already).

 

[Bromptonaut]

Impossible to know, in this specific case, without more information, but, both my wife (a trained Nurse) and my younger brother (a retired Fire Fighter) have had occasion to (successfully) perform a Heimlich Maneuver, when people have choked on food in restaurants. I am ashamed to say, I have no idea how to. do this, but, perhaps it should be included in training requirements of care staff (if it is not already).

More information needed.

Exactly.

Has the coroner publishes a decision with reasons, or suggested that a Prevention of Future Deaths report might be appropriate?

 

[Beebo]

Impossible to know, in this specific case, without more information, but, both my wife (a trained Nurse) and my younger brother (a retired Fire Fighter) have had occasion to (successfully) perform a Heimlich Maneuver, when people have choked on food in restaurants. I am ashamed to say, I have no idea how to. do this, but, perhaps it should be included in training requirements of care staff (if it is not already).

It’s taught in basic first aid.
Clench fists under rib cage and a sharp pull forward and up.
Failing that it’s bend them over and firm strikes to the back.
All care home staff will know this. Choking is common with elderly folk.

 

[Craig the cyclist]

This is easy, the answer is that it depends what is written on it.

 

[Bromptonaut]

The Coroner produced a Prevention of Future Deaths Report to which the Nursing and Midwifery Council and the relavant Adult Social Care team have responded.

https://www.judiciary.uk/prevention...rt-murray-prevention-of-future-deaths-report/