Practice dilemma - Dementia patient's care plan

04 November 2010

The Dilemma - You are called to a nursing home to see an elderly man with a chest infection. In his care plan, it states he would like to be cared for at the home and that he would not like to be transferred to a hospital should he fall ill. After reviewing him using the CRB65 assessment tool, you note he has severe pneumonia and is at risk of death. His daughter is present and comments on how confused and breathless he is. You explain that he needs intravenous antibiotics and oxygen in hospital but unfortunately his care plan states that you have to treat him in the nursing home, which does not have the facilities for oxygen or intravenous drugs. She objects to this and, despite the care plan, insists he is transferred to hospital. What should you do?