KNOXVILLE, TN – In a palliative care-run family meeting that has gone completely awry, a patient and family has made their multidisciplinary inpatient medical team DNR/DNI with comfort measures only.
“This is certainly not the outcome any of us were expecting,” said palliative care nurse practitioner Alison Husk, standing bedside a chaplain and both the patient’s nurse and hospitalist. “But truth be told, any time anyone can be made DNR by the end of a family meeting it really should be considered a victory. It just so happens it’s all of us.”
Though we are unable to fully disclose the details of the patient’s medical condition, the patient did have several chronic medical conditions that were unfortunately end-stage. According to palliative care, the patient had a life expectancy of 6 months or less and was eligible for hospice.
“The patient and family are very reasonable and understanding of the situation, realizing that cure was not possible and that comfort was the best course of action,” said hospitalist Sean Grimes. “That was why after a really productive 75 minutes of discussion they made our team DNR/DNI with comfort care measures only. Everyone in that room was on the same page, myself included.”
The medical and palliative care teams have already met with a hospice agency and it appears that all would be agreeable for inpatient hospice.
“The nurse, charge nurse, hospitalist, subspecialists, and everyone on Palliative Care have uncontrolled symptoms of stress and fatigue, and could benefit from being started on a Dilaudid PCA in inpatient hospice, at least to get them a little more comfortable,” said hospice liaison David Loveless. “Now let’s cross our fingers a bed opens up: our inpatient hospice unit is currently filled to the brim with burned out medical teams.”