Hey guys I have a really important question to ask. I just graduated this may and currently working in a nursing home. I have one resident whom just coded today.
Upon arriving on shift, my unit manager told me that the patient is still full-code and not DNR. The DNR out-of-hospital order form is still haven't been filled out by the doctor, hospice, and the nephew (the responsible party of the resident).
While doing rounds and preparing to put on wound care dressing on this resident I saw that she was having trouble breathing and using her accessory muscles. I immediately took her vitals and Sp02. The Vitals were BP= 89/53 Pulse= 116 Respirations= 27 and Temp 97.4. Her Sp02 was 85% and steadily declining. I called respiratory right away to give her some oxygen which her sP02 increased to 79%.
I had to call 911 to come pick her up.
The question is I saw in her chart that the doctor did put down DNR and sign it in one of those receipt attachment form. However, it wasn't an official out-of-hospital DNR order form. I called the director of nursing and she told me the patient is DNR. I rush to the patient's chart and pull out that particular DNR form to show to the EMS people. They told me that form isn't valid because its one of those tear off form. It has to be an official out-of-hospital DNR form for her to be DNR. They took her to the hospital.
I'm really worried because 1) there was a DNR order from the doctor. 2) The doctor nor the nephew has officially sign on the out-of-hospital DNR order form.
I'm stuck between which one to follow. I'm really stress out right now. I had to stay back 4 hours to do paperwork and check if everything was correct. I did saw in the chart that her last advance directive flowsheet was done on 10/19/11 which was 2 years ago. That one still listed her as full-code and not DNR.
Nov 10, '13
by Esme12, ASN, BSN, RN Senior Moderator
A DNR is not a do not treat. You administered oxygen.....perfectly acceptable. You called 911...again Ok. Just because someone is a DNT doesn't mean they shouldn't get lasix to help them breathe or antibiotics to help a urinary tract infection.
A DNR means you won't do CPR or perform life saving measures...like intubation, defibrillation, and pressors.
Without a signed DNR there is no DNR.
is incorrect about EMS having to have to do CPR. I believe that all states have out of hospital DNR status which when signed allows EMS to withhold resuscitative efforts.
In my state it is called Comfort Care.... MOLST and Comfort Care DNR Verification
In PA it is called a out of hospital DNR order.....DNR Order - Pennsylvania
TX out of hospital do not resuscitate order...http://codes.lp.findlaw.com/txstatutes/HS/2/H/166/C
Do Not Resuscitate Orders and Comfort Care Ohio
Are a few examples....But these need to be filled out and signed for them to be valid.
Last edit by Esme12 on Nov 10, '13