Very important information on DRO'S

Hi All

Need to share this!!

My Dads clinical nurse specialist from the hospice came out today and after seeing Dad, Mum and I had a private 10 minutes with him. I was asking about what happens upon death and procedures. He then asked to see Dads do not resuscitate order and noticed it was issued in July 2016, he said in palliative care cases it is 'good practice' to have this updated by the GP every 6 months and he will now arrange this with the GP! Secondly when my Dad passes he told us not to be alarmed but a coroner will most likely be involved.

Basically if your GP does not visit the PSP patient approx every 3 weeks it IS necessary for the DRO order to be updated every 6 months.

You may or may not wish to take note x

30 Replies

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  • Thanks - Liz will update when she sees the GP on Wednesday.

    The medical profession tend to put all these things in place because they want to be very sure that everything is valid.

    However even one written at home is completely valid under the law, even if it is three years or whatever old. They are bound by the law and cannot really add these rules in. Its all about their comfort zone.

    Thanks for posting this... We will renew just to avoid hassle

    Cheers

    Kevin

    xx

  • I agree Kevin, update to avoid problems x

  • Weird! Colin had his DNR form for over three years without a review. I had to take it to the Hospice every week and every time he went to the hospital. Is it to give folk a chance to change their mind?

    Colin was seen by the doctor two weeks before he died, the first time he had called for many weeks. Unfortunately the GP had an operation on his shoulder soon after so couldn't write a report after Colin died. It was therefore referred to the coroner. I had a phone call from the assistant coroner and a few days later from the coroner. I had to explain to both exactly how death took place and how I was caring for him, if I gave him drugs etc. Both men were very kind and asked questions in a sensitive way. I also had to explain the same to two independent doctors who phoned on different days as they had to inspect Colin's body as he was going to be cremated.

    X

  • Bless you NannaB I don't believe it's if they change their mind, just good practice?!

    Stressful and difficult subject but one I thought I should address with everyone x

  • Hi Sat, always better to be safe than sorry. Best to be prepared, though a difficult subject, than have it all suddenly thrown at you which is more upsetting. On a lighter note, how's the new job going ? Ljinglesx

  • Indeed Jingles!!

    Ooh yeah thanks for asking, I meant to write a post letting you all know, I worked Friday and Saturday it's wicked!! Right up my street, lol, very casual, full of locals, simply very nice! An 'extremely' good way to switch off for a few hours! I don't mean that horribly but whilst I'm there I'm not constantly focusing on my Dad and bloody Psp!! I realise that sounds rather off but darlings, I think we all need some relief from caring?! Again I feel dreadful saying that because I do appreciate it's a million trillion times worse for the Psp patient!! X

  • Gosh NannaB

    That was a lot to handle on top of the loss of Colin.

    xx

  • Yeah I thought that Kevin 😓

  • I need to get this in place for Mum as we've had brief discussions but nothing down on paper.

  • Do it Spiral! It's good to have it all written down x

  • I intend to following seizure as I thought I was going to have to make the decision that day on whether to or not and Mum had said to me do not resuscitate me but when staring it in the face it was a whole different ball game. I spoke to Admiral last week about it and other advance care plans decision and she is going to arrange for one of the nurse specialists to come out and have the discussions with Mum so I don't have to do it.

  • That's a really good plan Spiral!! It's not an easy subject and one that most people leave too late 😓

  • Yes indeed and whilst Mum still has capacity want her to make these decisions for herself. Her cognition is worse following the seizure so don't want to leave it on my mental to do list anymore.

  • Quite! X

  • Thank you Amanda we have never been told this, we have one on file, will speak to the GP about it xxxxx

  • Me neither Yvonne hence the need for sharing!! Dads CNS (clinical nurse specialist) will be very interested in all your replies! I told him I'd post this!! He is a diamond amongst diamonds 💎 x

  • Hi Satt

    Well as is my way I went and read up on this.

    In the UK it relies on Article 8 of the Human Rights Act. Which is a general right and not specific to this situation. Doctor's thus have some leeway.

    So meeting the medical professions comfort zone is important.

    Having said that an LPA which states a desire not to be resuscitated caries a full legal weight. However even then I think the Doctor has some say as to whether it should be applied.

    For example if the patient with a DNR was choking on a peanut and blacked out the Dr might be ill advised to shrug and walk away if it could be resolved with a little ventilation.

    It seems the Medical Profession has been seeking clarity for quite some years.

    Thanks for the heads up on this one.

    Cheers

    Kevin

    xx

  • As usual Kevin you are utterly fabulous how you read up on everything for us!!!!

    So are you saying you agree the DRO should be updated 6 monthly or not?

    I trust your opinion 100%, equally I trust Dads CNS!

    I think this is a very important issue to tackle! X

  • Just going on what I have read on Medical Law sites. I am totally no expert on this.

    Your original advice was very good.

    The medics have quite a bit of leeway with these things it seems. The DNR is effectively (and legally) an Advanced Decision. That means the Dr has to respect it, but he has to respect it withing the circumstances he sees in front of him/her. So in the example of someone choking on a peanut who needs ventilation to bring them back they probably would not go with a DNR. However someone close to the end of their life, or with a serious illness like PSP, then if they had a full Cardiac arrest they probably should go with it.

    So any thing which gives them the confidence that the DNR is really what the patient wants then they will be more confident going with it. Most of the recent case law seems to pertain to Doctors putting a DNR on file for a patient without consulting them and whether or not they should consult the patient if it were to cause mental harm, or have no capacity to make a decision.

    In short the area is unclear with regard to the law.

    As you say. it is an important issue. I am so glad you flagged this and gave us the advice you did.

    Thanks Satt, you've done anther good one :)

    Hugs

    Kevin

    xx

  • Bless you K!! I think, actually, your advice, is as always much respected, so thank you!!!!! X

  • I agree, but this is a grey area. I am fairly confident I've got it right.

    Only fairly so.

    :)

    Hugs

    Kevin

    xx

  • Ha ha

    Only fairly confident?!!

    You I'm sure are right as per! 😆 X

  • Well Satt

    I'll let you into a secret.

    I have been proposed for membership to the BIN.

    The British Institute of Nerds.

    The problem is the Institute was immediately flooded with Nerds who specialised in Constitutions. Ten years on no progress has been made.

    Then Nerds specialising in confidentiality got involved and so no-one can communicate with each other either.

    It's a frustrating thing... So I have resorted to Gin... Generally irritating nerd.

    I'm so glad you raised this one, seriously. We would likely have been caught by it.

    We will be following your advice.

    Hugs

    Kevin

    xx

  • Thanks Satt for sharing. W says he doesn't want a Peg or any intervention and when I suggested putting this in writing he said 'sometime'. He's due to see his GP soon so think I might ask him to talk it over with him. Great news you're getting a break from PSP with your new job, you deserve it. Lots of love Nanny857 xx

  • Yes nanny I'd definitely get the gp involved in the discussion, it's good to have their input and advice and reassurance!

    Bless you thank you, the new job gives a bit of normality as I sit here and cringe watching the DN insert suppostries!! Oh yes, constipation again 😓 X

  • GP every 3 weeks?!?!??! Don't make me laugh Amanda!!! Xxx

  • I know, joke eh, Suze x

  • Thank you xx

  • We used to have a yearly one for Steve issued by the community matron. However when he went into a care home they said we needed one which was everlasting. We asked the community nurse for another and she said yes we needed an everlasting one which she duly issued. Not sure if this applies just to Kirklees or for all England. We also have had to have the doctor today to put in place a no peg on his record. I really had to fight for that one as I was worried he wouldn't be able to give his consent later on as I know he def didn't want one fitting. Interesting in that she asked him if he would have medicine put through a peg if not food. Refused both so hopefully they will just make him comfortable when the time comes.

    Horrid times

    Pauline xx

  • Thx you for sharing Pauline x

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