Signed State DNR form no good????

[llltapp]

AAAAAAAAAAARRRRRRRGGGGGGGGGGHHHHHHHHHH I just got home from work and I am furious. I had a guy who was AAOX3 and doing great up until he stroked out this morning. I got report that he stroked out at the nursing home. Came to us with a fully executed State DNR form from the DOH. The admitting doc refused to write DNR because she is not the patient's primary care doc and must speak to the family first............???? What's the point of a DNR signed by a fully competent individual and his own doc??? Better yet, they sent him to ICU with full code status while we had vent patients in holding in the ER. I called the admitting doc back trying to downgrade him and get the DNR activated.......... nope. I am not doing anything til I talk to the family. No family available. He wasn't vented, not TPA'd nothing. ICU full code. How can we say make sure you fill out your forms and make sure they go to the ER with you if we aren't honoring them. Disgusting. Thank you for listening.

[Straydandelion]

I have had similar issues with other patients and it is very confusing. Patient A comes in unconscious, heart attack, stoke ...goes downhill, has a DNR per patient request yet family members want everything done. Therefore, the patient is full code and obviously after a length of time won't improve. Attempting to talk to family etc. sometimes this is resolved and a DNR is written, sometimes not. I no longer have the link but read one patient that went through this and DID improve even sued the institution for not following their wishes. In talking to some it seems the idea is "whoever can sue" seems to be uppermost rather then patient expressed wishes. I am curious what the legal aspect of a situation like this is.

[BrnEyedGirl, BSN, MSN, RN, APRN]

I feel your frustration. This has been going on for as long as I can remember. We encourage people to make their wished known, to put it in writing,.many people hire an attorney and spend a great deal of money to write things out in detail only to have this happen. I've also seen situations where the pt has made his/her details very clear on paper, then a great niece that hasn't seen the pt in 20yrs shows up and insists we do everything we can to keep "dear uncle Jim" alive. The problem is that this great niece will be alive to hire an attorney after the pt dies. I would love to see just one big lawsuit filed by a loved one because we didn't follow the pts wishes and now the pt lies in a nursing home for months or years unable to care for himself and unaware of what is even going on. Just once I would love to see a family member who steps up and says "this isn't what he wanted, he had it in writing, signed by a doc and you coded him anyway, now you can pay to take care of him"!!

[BabyLady, BSN, RN]

To me, physicians overriding a DNR request signed by the patient (regardless of what the family thinks), is playing with the legalities of it.

If I am that bad of a shape, and I've signed a DNR...if I found out a physician didn't follow that....if I am alive enough to communicate, I would be contacting an attorney.

To me, a patient's wishes should override EVERYTHING.

[rjflyn, ASN, RN]

Depends on the state, depends on the form. For example I just recently moved from Fl we had a yellow prehospital DNR form that was only valid prehospital. If the family or patient wanted it extended in the hospital they needed to have a living will and/or a DNR by the attending MD.

But what my years of experience has shown is that when a pt presents there is a pile of papers, someone has started resuscitation and we will continue it until we sort out the pt and families wishes. As its better to err on the side of doing to much than on the side of not doing anything.

[BabyLady, BSN, RN]

Depends on the state, depends on the form. For example I just recently moved from Fl we had a yellow prehospital DNR form that was only valid prehospital. If the family or patient wanted it extended in the hospital they needed to have a living will and/or a DNR by the attending MD.

But what my years of experience has shown is that when a pt presents there is a pile of papers, someone has started resuscitation and we will continue it until we sort out the pt and families wishes. As its better to err on the side of doing to much than on the side of not doing anything.

But that isn't the situation that the OP posted....or what I was referring to. I'm not talking about a situation where no one can find the paperwork.

The nursing home had a fully executed DNR and the doctor refused to adhere to it.

What is there to debate when someone brings it in with the patient? I'm not talking about what most doctors usually do...they are taking advantage of the fact that when someone codes that the patient usually is not in a position to speak for themselves, and they are "worried" about pleasing the family. If a physician has a patient signed, DNR in front of them, and the state allows them to follow that DNR...then the physician doesn't really have a reason not to follow it.

The physician's first obligation is to the patient and following the patient's wishes. It is very, very sad that a patient's wishes are not respected.

[rjflyn, ASN, RN]

See that was the problem, if someone ignored that yellow prehospital DNR in FL which is perfectly valid for the EMS crew and the nursing home it was not valid at the hospital. So unless we had further instruction from the pt or family it was basically optional to follow that DNR or not. In my ED most DR's would go with it, but there were a couple no way. Same with if it wasn't on its original yellow paper, if it wasn't yellow it wasn't valid even though the form said a copy was valid as an original. Their the MD so what can you do?

[med/oncRN]

Our hospital it doesn't matter unless the MD orders DNR. The EMS will follow the state DNR if it is shown to them, but in the hospital what goes is what the doc writes. Unfortunate.

[guy_nurse]

When I get to that point in my life I'm gonna have "ATTN: I'm a DNR" tattooed on my chest.

[Aneroo, LPN]

Depends on the state, depends on the form. For example I just recently moved from Fl we had a yellow prehospital DNR form that was only valid prehospital. If the family or patient wanted it extended in the hospital they needed to have a living will and/or a DNR by the attending MD.

But what my years of experience has shown is that when a pt presents there is a pile of papers, someone has started resuscitation and we will continue it until we sort out the pt and families wishes. As its better to err on the side of doing to much than on the side of not doing anything.

I can understand that.

In this sue happy country we live in, I think most would rather code someone and get yelled at for it later than NOT code someone and have someone sue because "you didn't do anything to save billy bob".

[Aneroo, LPN]

Depends on the state, depends on the form. For example I just recently moved from Fl we had a yellow prehospital DNR form that was only valid prehospital. If the family or patient wanted it extended in the hospital they needed to have a living will and/or a DNR by the attending MD.

But what my years of experience has shown is that when a pt presents there is a pile of papers, someone has started resuscitation and we will continue it until we sort out the pt and families wishes. As its better to err on the side of doing to much than on the side of not doing anything.

I can understand that.

In this sue happy country we live in, I think most would rather code someone and get yelled at for it later than NOT code someone and have someone sue because "you didn't do anything to save billy bob".

[azhiker96, BSN, RN]

I think this discussion illustrates the importance of having a MPOA designated and ensuring that person believes the same way you do. A MPOA does not have to be a family member and sometimes it's probably better if they're not. My MPOA is my wife but she's also a hospice nurse and we agree on heroic measures. Also, she knows if she goes against my advanced directives I'll come back and haunt her!