family decision regarding end of life

Every family has to come to a decision regarding end of life at some point.  In the case of the COVID pandemic, families are making this painful decision at a moment when they are not even able to visit with the patient.

In my ER, a patient came in from a memory care facility where multiple residents tested positive for COVID, including my patient.  When he arrived his sats were at 68% and we was on a non-rebreather.  We switched him over to a high flow oxygen and his O2 went up to 95%.  He had Alzheimer’s and communication was difficult.  There was no DNR in place for him and I contacted his daughter, who is his proxy, to let her know his current situation.  The admitting doctor spoke to her and they decided to put in DNR in place.  I Facetimed with her so she could say goodbye to her father.  It was the most heartbreaking thing I have ever done.  When we brought him up to the ICU he was stitched over to a nasal cannula at 2 liters and passed away shortly afterwards.  The family was unable to visit with him before he passed because he was COVID positive.

There was discussion about hospitals considering DNR for COVID patients so that staff is not put at risk because of PPE shortages (Masson, 2020).   Hospitals such as Northwestern Memorial Hospital in Chicago, are considering placing orders regardless of family and patient wishes (Masson, 2020).  This is an uncertain time, where we really don’t know where the disease process will go.  In another study it was found approximately 77% of participants believed the decision about DNR should a team decision which consists of the physician, nurse, patient, and the families (Tajari et al., 2018).  Many of these decisions are made when the patient is critical.

In finding the CPR decision aid for patients and their families on the Ottawa Hospital Research Institute site, this is a useful tool in aiding with this painful decision.  The tool went into detail about what occurs during CPR and lets families know what the outcomes would be and the small chance of a normal life.  There is an honest paragraph about the side effects of CPR such as broken bones, punctured lungs, and impaired mental function (OHRI, 2019).  When discussing this with families and the patient it is important to have an honest discussion so an informed decision can be made.  I will use this aid for work because it’s important to have open communication about the reality of life.

Tajari, M., Jalali, R., Vafaee, K.  Attitudes of patients’ relatives in the end stage of life about do not resuscitate order. Journal of Family Medicine and Primary Care.  Doi: 10.4103/jfmpc.jfmpc_144_18:10.4103.

Masson, G.  (2020) Hospitals consider do-not-resuscitate order for all COVID-19 patients.

The Ottawa Hospital Research Institute. (2019) Patient Decision Aids.