witnessing a DNR - page 4

We had a patient who was actively dying. The MD spoke with the family and they were deciding whether or not to make this patient a DNR. I went into the patient's room with the primary RN to see the patient; their eyes were... Read More

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    If for some reason the MD needs to make code status via phone, the order must be given to 2 RNs. No random people involved.

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    Missouri is the only state that requires two witnesses for DNR orders.

    Forty-nine states currently permit the next of kin to make medical decisions of incapacitated relatives, the exception being Missouri. Missouri has a Living Will Statute that requires two witnesses to any signed advanced directive that results in a DNR/DNI code status in the hospital.

    Excellent info on how to initiate discussions:

    Time to Resuscitate the Code Blue Discussion[
    Last edit by NRSKarenRN on Dec 14, '12
    wooh likes this.
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    I'm not a nurse (yet), but I would feel really awkward in this situation as a visitor of a patient. I would be dilly dallying too, trying to figure out what was going on and why I would need to be involved in a stranger's care. At the same time, if I really wasn't aware of how these things work, I would feel guilty just saying no. I would want to help, but it wouldn't feel kosher at the same time. You know?

    And if hospital staff woke me up for something not related to the patient I knew, that hospital would be getting some bad reviews for sure.
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    Quote from turnforthenurseRN
    The story is told exactly as it happened. No details were omitted, as much as some would like to think, it seems :/

    Thanks for everyone's input.
    It is just that you can't ask complete strangers to witness another patients document. I have seen hospitals do some bizarre things in my day but if they really do this.....it's right up there in the top 10!
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    In my institution, an Advanced Directive (being written by a competent, appropriate PATIENT) is witnessed by 2 people when signed. Basically, the witnesses are signing only that they saw the document being signed. Usually it is done by the hospital 'Pink Ladies' volunteers. Most often, there isn't a problem with anyone--patient, family, witness--feeling akward or put out.

    In a couple of isolated incidents, we have asked other visitors to be a witness. I work nights, so there's a lot of improvising going on.

    I had a patient who insisted on writing her Directive at 0200 in the morning. There was no Social Services or Pastoral Care available to help her, so the Charge Nurse (Me) had to.

    After filling out her Advanced Directive and Medical Power of Attorney, with her family's help, I rounded up two witnesses. I explained to the witnesses that I just needed them to watch the patient sign a document (nothing else disclosed to them) and sign their name as a witness that they saw the patient sign said document. Took about a minute, then all was done. No problems from patient, family, witnesses, or staff.

    But in a situation of an emergent DNR like described above, involving strangers doesn't seem appropriate. It seems like the 'witnesses' in that situation would definitely make it an uncomfortable HIPAA violation.
    DeLanaHarvickWannabe likes this.
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    That is a strange situation indeed!
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    In the state of nebraska (where I practice) nurses cannot be witnesses to DNR's and the family does need to sign but only one witness is needed.
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    Quote from traumaRUs
    Huge HIPAA violation and doubt this is the whole story. No institution could get away with this.
    I agree. I can't imagine asking visitors to sign a DNR. How is this NOT a violation? And for the record, from what I read in your post I think you did try to strong arm this visitor. As soon as you realized she was reluctant, that should have been the end of it.
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    Quote from turnforthenurseRN
    Trust me, I am NOT okay with the policy. I agree, there are a lot of issues with it and I think it is wrong, but for whatever reason no one has ever said anything about it. Perhaps I can take the issue at hand myself to risk management or whoever.

    The "witnesses" did not go into the patient's room.
    If they don't go into the room (which, by the way, is a HIPAA violation because you're now disclosing PHI to people that do no have a need to know) what are they "witnessing"?
    DeLanaHarvickWannabe and psu_213 like this.
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    I remember in the hospital that Hospice ruiquired witnesses to DNRs for ambulance transport, etc. The DNR in the hospital was an MD order, but there was something about when the patient went with Hospice. I also remember family and hospital employees could not witness it, but now I'm unclear what it was.

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