another scenerio

If they want sent then you have to send them. Then it is up to the EMS what goes on after that. Them and the hospital.

DNR means "Do Not Rescuscitate." It does not equate to "Do not treat."

I have sent very sick DNR patients out to the hospital per their request, because they still must receive healthcare regardless of their code status. We still must treat patients with DNR status, but we are not to revive them if they die.

100% agreed. I am always amazed at the misperception with this. DNR only means not to revive.. it does not mean let em die. We even have a couple of Drs. that need reminded of this.

If someone wants to be transfered to the hospital, that is where they are going.

DNR should be changed to DNAR---do not ATTEMPT resuscitation....otherwise it's misleading. We don't often actually resuscitate them....

If the patient is alert and telling me this, I had better follow up and not just ignore what the patient is telling me. If there is a guardian or POA I'd be on the phone with them and definitely with the patient's doctor telling them what the patient's condition is and what the patient is saying. I'd probably press the doctor for an order to send the patient to the hospital. I wouldn't call 911 unless there was an actual emergency and the patient actually codes. A patient has the right to rescind their "No Code" orders at any time. The minute they do that and they are about to code, you must notify the doctor.

This is a bit off topic, but if you think you should send someone out 911, send them and then get the order. If you wait for the doc to call back it might be too late.
I've argued with docs about this issue. I had a patient who was a DNR and was in significant respiratory distress. I called the doc and told him I was going to send her out rescue. He said.."don't bother-she's old, she's demented, she smokes, she's a DNR and the hospital ER is jammed and they are diverting to another town."
I replied-she might be a DNR but she's not dead yet, she's not so demented because she can remember all her kids' names, her grand kids' names and MY kids' names, and how would it look on the front of the newspaper DOC REFUSES TREATMENT BECAUSE PATIENT SMOKES"
Needless to say, I sent her. She was fine after a few weeks and lived another 5 years in relative good health.

But see, my goal is to get them out BEFORE they code (and I don't mean to imply that I would 911 w/ lights/sirens just anyone/anything either). But if I get that feeling that they are going bad and they want to go.. then they are as good as gone (preferably to ER and not to heaven). I will call Dr/family as soon as I can get to it, before if possible, after if not.

Hmmm... this remindes me of an incident in which an alert resident was choking in the dining room of a facility I once worked in. The LPN on duty first walked over to the nurses station, looked to see if she was a full code, saw that she was a DNR, so what does she do? She DID NOT administer the Heimlich, the PM supervisor, who was her friend and somewhat timid, agreed with this and also did not administer Heimlich, 911 was not called, this resident was allowed to die by asfixiciation, autopsy confirmed this.No one was fired or disciplined, family just let it go. The only thing that came of this was a memo to nursing staff that we must do the Heimlich and call 911 in case of choking, even with a DNR order, duh. I and other nurses were horrified this went down the way it did, wow, would we let a resident burn to death, just because they are DNR? This particular facility was considered to be one of the best in the city. Easy to make a facility look good to state, and family when so many things are so well hidden.Wonder what prospective families were to say if they would've known this had occured and those involved were merely corrected with a memo? Just one of the bad memories of my 30 years in LTC. Some good memories too. I was glad to be able to do the small part I did in making my patients life a bit better at the end of theirs, and THAT will always give me satisfaction of a job well done.

The above reminds me of a situation we had recently. I work in LTC doing MDS. I had the LPN come request that I look at at patient. I went out and before I even got in the patients room, I could hear her breating. RN supervisor was doing nothing!! I had the LPN get a chest x-ray. She had bilateral infiltrates. RN did nothing because patient was a DNR. She could not figure out why we were doing something. UH.........you don't let someone die from pneumonia when they have nothing else wrong with them!!!! DUH!! She never did get it. Only said, "She is a DNR!" By the way, this woman did end up in the hospital and died from it.