DNR orders

  1. Do you know the DNR/full code status on all your residents off the top of your heads? Seriously. Forget the bracelets or other ways that indicate a DNR. (except the doc's order) You may think he/she is, but aren't quite sure. Our supervisor says all nurses should know the code status of each pt. :chuckle In an emergency? ................:stone
    I'll be quite honest that out of 60 residents there are maybe 10 I can say right off the top of my head that I 100% know are DNR. BUT, is the order expired? :uhoh21: I'm supposed to know this off the top of my head because running to the chart/computer is a waste of time in an emergency. Say the order wasn't renewed, pt expires. Now he's a full code. Pt/family doesn't want a full code. :angryfire So if a pt has a DNR order, why does it have to expire? He should either be a DNR or not unless, of course, the pt/family changes their mind. :smackingf :selfbonk:
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  2. 29 Comments

  3. by   steelcityrn
    they better come up with a better system than what they have or they will pay heavily when a family sues them for neglegence
  4. by   night owl
    You're telling me!
  5. by   Bird2
    I've never heard of a DNR expiring in LTC. They review the code status at each care plan meeting but I've never seen a family say Hmm Mom's been DNR for 2 years let's try her being a full code for awhile! How goofy!!!!
  6. by   night owl
    Quote from Bird2
    I've never heard of a DNR expiring in LTC. They review the code status at each care plan meeting but I've never seen a family say Hmm Mom's been DNR for 2 years let's try her being a full code for awhile! How goofy!!!!
    At our facility, a DNR order is good for 90 days and has to be renewed or else it expires. The pt then automatically becomes full code because he/she doesn't have a DNR order. I just don't understand why this order has to be renewed period. Do other facilities have a straight DNR order that never has to be renewed unless the pt/family changes their mind? The Doc will ask an A&O pt about the DNR and he says "yes" then in a few days or so they may ponder and come back and change their mind and want to be a full code. If the family wants DNR, they rarely ever change their mind. But I'm wondering about this order and why it has to be renewed. It doesn't make sense to me that you have to renew it in 90 days or it expires.
  7. by   suebird3
    Quote from bird2
    i've never heard of a dnr expiring in ltc. they review the code status at each care plan meeting but i've never seen a family say hmm mom's been dnr for 2 years let's try her being a full code for awhile! how goofy!!!!
    same here, fellow bird.

    sb
  8. by   nurse4theplanet
    I work in ICU and have at most three pts...so yeah...I know haha

    but during clinical this past semester, my instructor made a comment during preconference (telemetry floor) that even if a DNR order was written in the chart, at the very least chest compressions and other non invasive measures would be done anyway for legal reasons...

    can anybody explain this further to me...kind of confusing.
  9. by   UM Review RN
    Quote from asoldierswife05
    I work in ICU and have at most three pts...so yeah...I know haha

    but during clinical this past semester, my instructor made a comment during preconference (telemetry floor) that even if a DNR order was written in the chart, at the very least chest compressions and other non invasive measures would be done anyway for legal reasons...

    can anybody explain this further to me...kind of confusing.

    On our Tele unit, if we did chest compressions on patients who had a DNR, we'd get sued. No suctioning, no chest compressions, nada. DNR means Do Not Rescusitate. CPR is a form of resuscitation.
  10. by   joyflnoyz
    We have an "Out of Hospital DNR" form-- I think it may be a "texas thing".
    Resident signs <if competent>, more often family member who is MPOA signs.
    2 witnesses, not related. physician signs. then they all sign again at the bottom of the page. physician then writes an "OOH-DNR" order. As far as I know, it never expires, although resident / family may change mind at any time.
  11. by   nurse4theplanet
    Quote from Angie O'Plasty, RN
    On our Tele unit, if we did chest compressions on patients who had a DNR, we'd get sued. No suctioning, no chest compressions, nada. DNR means Do Not Rescusitate. CPR is a form of resuscitation.
    Well, that is exactly what I thought which is why I questioned her about it. She just kinda blew off my concern and said it was to cover their butts in case the family blamed them for neglectful care that lead to the pt going downhill in the first place...

    so, it makes me nervous...what if I do and get sued and what if i dont and face backlash...glad i work in ICU and everything is soooo much clearer in this aspect
  12. by   nurse4theplanet
    Let me add this too...

    The whole reason we started on the conversation was that a student brought up the fact that she had an extremely ill aunt (COPD, h/o multiple strokes, etc.) that had her lawyer draw up papers on her to keep on her person in the event something happened to her in a public place (say she dropped in the grocery store) to allow others to know she was not to be resuscitated, etc. She carried it right with her med alert stuff, id, and allergy info. She was at an aquaintance's house, not a very close friend, and went into respiratory arrest, passed out, and the other person called an ambulance. They found her paperwork and all her medical stuff on her person but performed basic life support and eventually she was intubated at the hospital until the doctor and family was notified and then she was taken off life support. Do EMTs have to do resuscitation no matter what? Logically, they are medical professionals not legal professionals, and probably would not be able to verify/recognize the authenticity of the records. I think the family is preparing to sue the hospital, but I don't know if they will have much validity to their claim...

    but that is the conversation that sparked my teacher's comment and it has bothered me ever since.
  13. by   nialloh
    Quote from asoldierswife05
    I work in ICU and have at most three pts...so yeah...I know haha

    but during clinical this past semester, my instructor made a comment during preconference (telemetry floor) that even if a DNR order was written in the chart, at the very least chest compressions and other non invasive measures would be done anyway for legal reasons...

    can anybody explain this further to me...kind of confusing.

    CPR is resuscitation, hence the name Cardiopulmonary resuscitation. If you do chest compressions, you are breaking the DNR. You will be leaving yourself wide open for legal action.
    In my hospital we do treat DNRs. We give meds, O2, suction, ect. We only stop at CPR and intubation.
  14. by   nurse4theplanet
    Quote from nialloh
    CPR is resuscitation, hence the name Cardiopulmonary resuscitation.
    that goes without saying

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