Warning-DNR forms are worthless

Nurses General Nursing

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I took care of my mother who had alzheimer's disease for the past 7 years. Everytime she was admitted to the hospital the very 1st thing I would do is to give them the POLST form that clearly said no CPR. However, it appears that the doctor didn't write an order for DNR. Thank God, I was physically present when she suddenly died. They called a "Code Blue" on her!!! :bugeyes:I was shocked. I told them "No,no she is not to be coded." So beware my friends, make sure if your loved one is a DNR to make absolutely sure that the doctor writes a "No CPR" order each and every time they are admitted to the hospital.

And it can vary, even inside a state. The hospital I work at requires a signed MD's order, regardless of all the state DNR forms you may wave. The site I do clinicals at just requires the state form and DOESN'T require the order.

God only knows how many folks who wanted to be DNRs have been brought back.....Go read my article called "The Patient I Failed."

It can vary depending on municipalities as well. There is one smaller community near where I live that has city-run EMS, and they only recognize their own DNR forms. Of course, few who live in the town realize that..........sooo. :angryfire

I don't know if this would stand a legal challenge, but some aggrieved Pt or family member who has watched EMS people code a DNR Pt should take it to court.

Specializes in ICU, Research, Corrections.

Thats why everyone needs a Healthcare Power of Attorney. This person can make all your decisions for you without interference from anyone else even your children/spouse.

I am 35, my daughter is 17. She already knows what i do and do not want regarding end of life. She will make the decisions.

Moral of the story- find you a POA, tell them what you want. POA papers are more binding than DNR papers.

I second this suggestion! Definitely one of the first things I do when either parent is hospitalized is make sure I am the MPOA. Due to the HIPPA laws it is at automatic mandatory item that I do on the first day of hospitalization. Another thing I like to do is have a doctor write an order that I can read the chart, (I figure it saves the nurse time and I can cut to the chase.)

Unfortunately, I lost my mother about 3 years ago - she had a massive stroke and was in a hopeless situation. I only kept her on the vent long enough to have all my siblings present for her death. I was so happy I could give her the best death possible; I knew what she wanted. We discussed it many times.

Specializes in Utilization Management.

My mom and stepdad had agreed to DNRs, but when he went into status epilepticus at the hospital, she promptly rescinded it.

It's one thing to say you're going to let a loved one die, quite another to be there and do nothing when it happens.

The lesson here is that no DNR is set in concrete. Probably why my hospital required a current DNR from the patient / representative and confirming orders by the doc.

This post has been extremely timely for me. When a person comes into our unit and they CLEARLY have a DNR and they CLEARLY do not want to be resuscitated, we are told and have been being told that DNR does not mean do not treat. I do agree to some of the treatments but not all. So we go through ALL measures including pressors, bipap, multiple labs, central lines, etc. etc. The last three DNR patients of mine were a man with metastatic colon cancer, family had been already presented with hospice, they wanted him comfortable. The MD wanted to drain necrotic tumor areas to decrease his "infection" and get him on the right antibiotic. The second patient, end stage lung COPD, stated "I am a DNR and I don't want to be intubated," her words, the next day the MD say "she's kind of sleepy,I don't think she can make that decision." The third patient, also COPD with a tumor in his hepatic flexure needing a colectomy and probably would not survive it, already saying goodbye and that he "was ready" made himself a DNR and when the tumor ruptured the family wanted to take him to surgery. Each time I stepped in and had to STRONGLY advocate for the patient's wishes.

When we intervene with DNR patients we generally will seem them once a month or every other month for the same things. Sepsis due to RLL infiltrate probably due to aspiration, due to dementia or UTI due to poor intake leading to sepsis, leading to renal failure, etc etc. Then they are DNR but we treat.

I think all nurses will "enjoy" this one. We had a staff meeting this week. As nurses we ask code status of the patient or the patient's family, unfortunately many families will tell you their loved one wanted to die peacefully but when presented by the PHYSICIAN with do you want us to help your loved one get better, families will opt to treat for "one to two days" in order to "help" their loved one. In our last staff meeting we were told by our nurse manager that our intensivists would like us nurses not to encourage comfort measures until the MD can at least treat the patient for "one to two days" to be able to give the time for all the treatment options to start to work.

Last Friday I had a patient, DNR but went to surgery for toxic megacolon. She went to surgery, tubed overnight, extubated the following day. By Friday her WBCs were 88,000, not to mention the high lactic acid, low plts, low albumin, all kinds of signs the patient was not going to make it. Her sats started to drop and in the am the physician asked the family if she could intubate in to "help her out for a couple of days." They said "we will have to think about it, she did not want that." When her sats dropped, the MD called the family, told them the situation of her sats dropping and that she wanted to intubate "to help her out." She was intubated, still is, on pressors, bloated to twice her size, guppy breathing on a vent and she was a DNR. So now instead of her family seeing a beautiful mother and wife pass "naturally" at 81, they will see her as she is now. It was promised to that family the tube would come out this past Monday, it did not because another doctor is covering.

I would implore all nurses especially LTC nurses to encourage families and explain to families what happens in hospitals and get "do not hospitalize" and to get "comfort measures only" and to help families stick to their loved ones wishes. Thanks

PS My mother had alzheimers and died three years ago, I was called twice by an NP at her nursing facility to see if I wanted IV fluids. The NP was very understanding when I asked what for. But yet it has left me feeling at times my mother would have lived longer if she had the fluids, but she never wanted to be in a nursing home and we discussed that before she got alzheimers. I had to stand my ground for her and know I was making the decision for her and not me.

Specializes in Nephrology, Cardiology, ER, ICU.

I'm so sorry for your loss.

Thanks all for your replies.:D God has truly blessed me. I had the priviledge of taking care of my mother at home for the past 7 years. She was pleasantly confused most of the time. I sure do miss her! Anyway, I thank God that I was physically present when she died and was able to stop them from doing a code on her.:yeah:

Specializes in ER.
This post has been extremely timely for me. When a person comes into our unit and they CLEARLY have a DNR and they CLEARLY do not want to be resuscitated, we are told and have been being told that DNR does not mean do not treat. I do agree to some of the treatments but not all. So we go through ALL measures including pressors, bipap, multiple labs, central lines, etc. etc. The last three DNR patients of mine were a man with metastatic colon cancer, family had been already presented with hospice, they wanted him comfortable. The MD wanted to drain necrotic tumor areas to decrease his "infection" and get him on the right antibiotic. The second patient, end stage lung COPD, stated "I am a DNR and I don't want to be intubated," her words, the next day the MD say "she's kind of sleepy,I don't think she can make that decision." The third patient, also COPD with a tumor in his hepatic flexure needing a colectomy and probably would not survive it, already saying goodbye and that he "was ready" made himself a DNR and when the tumor ruptured the family wanted to take him to surgery. Each time I stepped in and had to STRONGLY advocate for the patient's wishes.

When we intervene with DNR patients we generally will seem them once a month or every other month for the same things. Sepsis due to RLL infiltrate probably due to aspiration, due to dementia or UTI due to poor intake leading to sepsis, leading to renal failure, etc etc. Then they are DNR but we treat.

I think all nurses will "enjoy" this one. We had a staff meeting this week. As nurses we ask code status of the patient or the patient's family, unfortunately many families will tell you their loved one wanted to die peacefully but when presented by the PHYSICIAN with do you want us to help your loved one get better, families will opt to treat for "one to two days" in order to "help" their loved one. In our last staff meeting we were told by our nurse manager that our intensivists would like us nurses not to encourage comfort measures until the MD can at least treat the patient for "one to two days" to be able to give the time for all the treatment options to start to work.

Last Friday I had a patient, DNR but went to surgery for toxic megacolon. She went to surgery, tubed overnight, extubated the following day. By Friday her WBCs were 88,000, not to mention the high lactic acid, low plts, low albumin, all kinds of signs the patient was not going to make it. Her sats started to drop and in the am the physician asked the family if she could intubate in to "help her out for a couple of days." They said "we will have to think about it, she did not want that." When her sats dropped, the MD called the family, told them the situation of her sats dropping and that she wanted to intubate "to help her out." She was intubated, still is, on pressors, bloated to twice her size, guppy breathing on a vent and she was a DNR. So now instead of her family seeing a beautiful mother and wife pass "naturally" at 81, they will see her as she is now. It was promised to that family the tube would come out this past Monday, it did not because another doctor is covering.

I would implore all nurses especially LTC nurses to encourage families and explain to families what happens in hospitals and get "do not hospitalize" and to get "comfort measures only" and to help families stick to their loved ones wishes. Thanks

Good for you for fighting the good fight. I am student but your last line reminds me of something a teacher told me (nurse for 40+ years), "If the patient wants to die, don't send them to the hospital since they are trained to treat people." My jaw just about hit the floor. It kind of twisted my thinking a little. All this touchy feely b---s--- about DNRs really is just that. Ideals are best left for nursing school, I guess. The system isn't designed to stop helping. lol

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