Changing code status to DNR/DNI

Nurses General Nursing

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There is something just so satisfying about locating your 95 year old demented patient's advanced directive in the computer and having the hospitalist change his code status to DNR/DNI...

Specializes in Family Nurse Practitioner.
We get patients from local nursing homes all of the time who are admitted as full codes. . .they are usually about 100 yrs old, dementia, FTT and admitted for either AMS or a fall. . .and when going thru their admission paperwork I find DNR forms! I HATE it. I call the doctors and get them to change the order in the computer but what if something happens during those couple of hours it takes a doctor to do anything? Would I have to jump on their chest??

I think "slow code" would be the ethical way to go..or get someone to change the order STAT.

Specializes in Family Nurse Practitioner.
I applaud nurses advocating for their patients when they are unable to communicate for themselves. It appears from this post that this patient took the time to prepare in advance by putting a legal advance directive together. These documents are legally binding and unfortunately go unnoticed way too often. If a patient chooses to have no cpr and to be kept comfortable then we must abide by this wish. I am a palliative care nurse and ask the all too difficult questions every day, however, when I ask a 96 y.o what their goals are for their care while they are in the hospital it usually comes in the form of "Oh honey, I told the doctor I didn't want to come back here to the hospital. I've had a good life. I just want to be back home with my friends and be comfortable. No one lives forever." POLST forms are used to transfer these wishes into a ACTIONABLE physician order. We may think we are protecting the patient from an uncomfortable topic, and don't wish to cause them distress in facing their own mortality. But believe me you are going to cause them WAY more discomfort, brutality and distress when THE GORRILLA enters the room to perform CPR. So please advocate, investigate and follow thru with patients wishes whether spoken to you or written in a legal document. This is what makes nursing the wonderful profession that it is. :)

Yes, the patient had a living will that said he did not want any lifesaving measures, even nutrition or hydration. He did specify that he wanted to be kept pain free.

Specializes in Emergency Department.
We get patients from local nursing homes all of the time who are admitted as full codes. . .they are usually about 100 yrs old, dementia, FTT and admitted for either AMS or a fall. . .and when going thru their admission paperwork I find DNR forms! I HATE it. I call the doctors and get them to change the order in the computer but what if something happens during those couple of hours it takes a doctor to do anything? Would I have to jump on their chest??

Slow code may be "ok" but you could consider calling EMS, if allowed by your facility. Just make sure you have all the paperwork handy... I doubt many Paramedics would continue working a code after a valid DNR was presented to them.

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