With-holding resuscitation on pt in the absense of a signed DNR order form? What?!

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MunoRN, RN

8,058 Posts

Specializes in Critical Care.

Ours is green, although a DNR by no means has to be written on green paper to be actionable, we just use green for the forms people keep at home to make them easier to find for EMT's/Medics.

If the MD discusses DNR with your patient and that is your patients wish, the doctor writes an order, which you confirm by discussing that with the patient, then the patient codes would you still so CPR on the patient because the MD didn't write it on yellow paper? If so because that's the system you have in Florida, I think it's the nurse's responsibility to stand up for the patient in those situations and make sure that the patient's wishes are upheld, particularly when the system that exists is purely idiotic.

Specializes in Med/Surg, DSU, Ortho, Onc, Psych.

I'm not in the US, but there is no way I would take a verbal DNR over the phone, even if the Dr had discussed this with the family recently. Family can REALLY misunderstand what the doctor says over the phone, whereas if something is explained to their face and signed, it's more clear and is a legal document. Also when people are distressed, they sometimes don't understand what is actually being said to them over the phone. I've heard of nurses doing this, and the the patients grave condition has been misunderstood or not explained properly to family, who have been annnoyed Granny has not been DNR (in one case I knew of, family was annoyed because they couldn't than get their hands on Granny's estate cos she wasn't dead yet!)

In Oz we must have a signed document and the doctor themselves must explain to the family what this means. But there's a big legal wrangle lately over what DNR actually means - it's a very ambiguous term - and what you should do if the patient survives a code, but is clearly not going to live for much longer.

neverdone

2 Posts

My question is who gets to determine a DNR for a patient if they are temporarily unable to for themselves?

neverdone

2 Posts

How about this issue Patient admitted to Hospice temporarily for pain medication with spouse determined DNR and all other medications were withheld including insulin in Florida . Does this sound right to anyone?

toomuchbaloney

12,694 Posts

Specializes in NICU, PICU, Transport, L&D, Hospice.
How about this issue Patient admitted to Hospice temporarily for pain medication with spouse determined DNR and all other medications were withheld including insulin in Florida . Does this sound right to anyone?

This sounds illegal.

The patient is "temporarily" dying within a 6 month time frame?

Who determined the DNR status?

Who discontinued the meds?

RunninOnCoffee

134 Posts

Specializes in ICU.

@neverdone- when a patient is incapacitated either temporarily or permanently the next of kin becomes the healthcare proxy. The proxy becomes the decision maker UNLESS there existing health care surrogate paperwork. In one unit I worked in all patients who were admitted axo were asked to sign a surrogate (not required just requested). I've seen more than one occasion where couples have separated for YEARS but never legally divorced..... Guess who legally is the next of kin.... Made for some very awkward circumstances since in 2 specific cases there was a new significant other that was not very friendly with next of kin..... So important to have your paperwork in order!

Your DON can be correct. The yellow DNR form is for out patient setting. (An assisted living is considered out Pt.). Inpatient hospitals have different rules. You are not required to have a yellow DNR form while IN THE HOSPITAL. The yellow form is the only only order that EMS can utilize. A doctors order on your order form or in the computer per your facilities policy is needed. However, to transport that patient outside the facility or to discharge them home they would require a yellow Florida DNR form.

MunoRN, RN

8,058 Posts

Specializes in Critical Care.
Your DON can be correct. The yellow DNR form is for out patient setting. (An assisted living is considered out Pt.). Inpatient hospitals have different rules. You are not required to have a yellow DNR form while IN THE HOSPITAL. The yellow form is the only only order that EMS can utilize. A doctors order on your order form or in the computer per your facilities policy is needed. However, to transport that patient outside the facility or to discharge them home they would require a yellow Florida DNR form.

The Florida POLST form is not required to be yellow in order to be valid in or out of a hospital, and it does not have to be yellow in color for EMS to utilize it. The form specifically states that while the original (yellow) copy is preferred, it is not required to be legal and valid. POLSTs are typically a bright color so they are easier to find for first responders, but it's not what defines it as actionable.

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