Case Study #6: Sepsis
Day 2: Medical Ward
Place Medical/Surgical Floor
“Dr. Pierce? My name is Jean. I’m the social worker for med-surg.”
“Hi, Jean. Yes, I’m Dr. Pierce. How can I help?”
“I was just talking with the family of George Thomas, and I believe an update with the family is a good idea. They seem to be over the shock of his admission and are ready for information.”
“Ok, I need to finish up here but then I could talk with them. It would be best if the nurse could attend, and the charge nurse and anyone else involved in his care. We should have a bit of a quick discussion before we talk with the family. Let’s say about 15 minutes from now.”
“Sounds good. I will round up everyone. Thank you.”
Jean, Dorothy the physiotherapist, Addy the nurse caring for George today, and Jennifer, the charge nurse, all join Dr. Pierce at the back of the nursing station.
Jean looks around at all the faces. “Thank you, everyone, for coming. This is about George Thomas and his family. The family seems ready for an update.”
Dr. Pierce nods his head. “Yes, he has had a trying time here, but I think he is ready for transfer back to Sleepy Hollow.”
Jean nods. “How are you thinking of approaching the family, Dr. Pierce?”
“Good question. I was going to review his care and how he has improved the last couple of days. Then I was going to broach the subject of sending him back to his home. I would also like to explain to the family that we should change his status to DNR level 2, meaning treating him at the care facility but no transfer to acute care. I believe this would be the best for George.”
Dorothy, a frown creasing her face, says, “Does that mean he won’t get treatment anymore and just die? That doesn’t sound right.”
Addy reaches out and touches Dorothy. “No, what Dr. Pierce is suggesting with the change to level 2 is that George will stay where he is most comfortable and familiar, and any conditions that he develops will be treated there. Transferring to acute care can be traumatic and uncomfortable. We are not abandoning him, but will provide as much care as possible to him in his home. If he does take a turn for the worse, he can die in the comfort of his home and not here.”
“Does that sound ok to you, Dorothy?” Dr. Pierce looks around at everyone. “I think it is important for all of us to agree on this change in code status. Much of the care on this floor is team-based, and right now you are the team looking after Mr. Thomas.”
Addy says, “I agree. We do some pretty uncomfortable things to people in their final days. Mr. Thomas would probably be more comfortable being treated at home than here.”
“Can he change his mind?” Dorothy asks, looking around at everyone.
“Oh yes. It’s not an absolute and patients can change their minds. In this case, with his existing disease conditions and how quickly he deteriorated with a minor UTI, I am not sure I would support changing his status, but it is a decision that his family and he can make.”
“Ok. If he can change his mind, I will support his change in status.”
“Thank you, Dorothy. Any other comments?” Dr. Pierce asks.
All shake their heads no.
“Ok. What I was going to do is have the discussion at George’s bedside. Is that ok?”
Jean nods her head. “Yes, that would work well.”
“Ok, we will all go in, introduce ourselves, and then I will review the care that he has received so far.”
“As I am the nurse today, I will add the nursing care he requires and talk about how much he has improved,” Greta says.
“From a physio perspective, he is mobilizing well and is a lot more steady on his feet. Family should know this,” Dorothy says.
“Excellent, everyone. Once the family has had an opportunity to digest this and ask any questions, I will bring up the change to level 2 code status. All agreed? Ok, let’s talk with the family and George.”
The discussion with the family and George went well. There were many questions and all were answered by the team. The following day, George was transferred back to Sleepy Hollow, his home.
- Please check the resuscitation codes and levels of care relevant to your clinical context. ↵