Rita Stevens’ mother was in the emergency room of Capital Regional Medical Center when alarms started going off. In a panic, Rita hit the button to call for help. As doctors and nurses filled the room, Rita realized they were preparing to revive her mother, and she stopped them. Rita’s mother had made it clear that, if her heart stopped, she didn’t want to be resuscitated. Rita was prepared to honor her mother’s wishes.
“She came back on her own. But had she not, I certainly would not have wanted drastic measures, and her ending up being on a machine for the rest of her life. That’s not what she would want,” said Stevens.
In 2005, Tallahassee Memorial Hospital began giving purple wristbands to patients who’d chosen to not be resuscitated if their heart or breathing stopped — in part to direct doctors in life-or-death situations like Rita’s mother faced. These patients are designated as Do Not Resuscitate, or DNR for short. On July first, TMH stopped using the wristbands. Some TMH healthcare professionals are concerned that not having the wristbands means there’s a greater chance of mistakenly performing CPR on a patient who doesn’t want it. Rita Stevens shares this concern.
“…and how awful would that be, to revive them enough to have them on life support, and then you’ve got to make the decision to unplug them,” said Stevens.
Dr. Brian Sheedy doesn’t think that’s likely to happen, though. He and Angie Marky are part of TMH’s palliative care team. They said the hospital has taken steps to ensure that hospital staffers know a patient’s wishes and follow them. Sheedy said patients’ wishes are documented on their digital record and on their physical chart. Marky said healthcare professionals won’t have a problem catching this.
“They’re gonna to be there with their, with the computer, and they’re gonna be looking at, who’s this patient? That’s the first thing they’re gonna see, and they’re gonna go ‘Whoa whoa whoa whoa, wait a minute, wait a minute, wait a minute, hold on,” said Marky.
But some patients’ wishes are still disregarded, if inadvertently. Scott Gwartney is a Tallahassee attorney who deals with medical malpractice lawsuits. Gwartney said he gets a call about once a year from people with similar claims of loved ones receiving treatment they clearly stated they didn’t want. He said he handled the case of a nursing home resident who was mistakenly resuscitated after having trouble breathing. Even though she had a DNR order, she didn’t have any visible indication saying so. She was intubated and survived for a number of days after the incident.
“But, due to this episode, this apnea, or lack of oxygen, her brain had suffered injury, and she ended up living out her last days exactly how she didn’t want to. And it’s exactly why she did the DNR card, undoubtedly, is she didn’t want to live that way,” said Gwartney.
Doctor Ken Brummel-Smith, chair of Florida State University’s Department of Geriatrics, said he understands why TMH officials decided to stop using the wristbands. But he also said privacy concerns may not be as important as public perception about what DNR means.
“I think part of the hesitation about the privacy issue is a little overblown. And in part, it’s because, although you’ll hear two sides to this story, in part I think it’s because DNR, do not resuscitate, let the patient die, has such a bad connotation,” said Brummel-Smith.
Nancy Foster, vice president of Quality and Patient Safety at the American Hospital Association, said hospitals are increasingly using digital records to outline patients’ treatment plans and wishes. She said it’s part of a balancing act between protecting patients’ privacy and respecting their wishes.
“And we wanna strike that right balance between making sure that we know that the patient is at a particular risk, or has this do not resuscitate order, and making sure that the general person walking around the hospital can’t identify patients’ identifiable information,” said Foster.
Tallahassee Memorial officials said they worried the wristbands weren’t secure enough – one reason they were discontinued. But Rita Stevens – whose mom was a DNR patient – said more still needs to be done before hospitals can truly claim they’re protecting patient data.
“I’ve been in patients where they have it over the bed, DNR, written on the file board or even up over the bed, so what’s the difference?” said Stevens.
Marky said she doesn’t know if an accidental resuscitation has ever occurred at TMH. She said this issue is something all hospitals have to deal with, and there is currently no national or state standard on how to address it.